NOVEL PREDICTORS OF NEW PERSISTENT LEFT BUNDLE BRANCH BLOCK AND PERMANENT PACEMAKER IMPLANTATION AFTER EVOLUT R TAVR

Abstract Aims Conduction disorders and permanent pacemaker implantation (PPI) continue to be an important issue in patients who undergo transcatheter aortic valve implantation (TAVI). The aim of this study was to investigate the incidence and clinical outcomes of new left bundle branch block (LBBB) and PPI after TAVI in a comparison between two self-expandable supra-annular transcatheter valves. Methods and results We report the data from an international, retrospective registry including 3862 consecutive patients who underwent TAVI with two self-expanding transcatheter heart valves (Medtronic Evolut R/PRO and Boston ACURATE neo). Patients with pre-existing left or right bundle branch block, any atrioventricular blocks or previous pacemaker implantation were excluded. Finally, we performed a propensity score matched analysis (PSM) to match the patients and overcome pre-procedural differences reaching 427 couples. New-onset Left Bundle Branch Block (LBBB) occurred with a rate of 13.1% (56/427) in the ACURATE group and 18.7% (80/427) in the Evolut group (P = 0.031). The incidence of new permanent pacemaker implantation was 16.4% (70/427) in the Evolut group and 6.8% (29/427) in the ACURATE group, respectively (P < 0.001). In the multivariate regression analysis, we found the valve recapture [odds ratio (OR): 4.66, 95% confidence interval (CI): 1.08–23.75, P = 0.042] as significant predictors for LBBB, and male sex (OR: 1.59, CI: 1.03–2.46, P = 0.036), ACURATE valve (OR: 0.34, CI: 0.20–0.57, P < 0.001) and post-procedure LBBB (OR: 4.38, CI: 2.78–6.85, P < 0.001) for PPI. Conclusions In our large multi-centre contemporary cohort of patients, new LBBB and PPI occurred more frequently in patients following TAVI with Evolut R/PRO vs. ACURATE valve. However, the choice of the valve seemed to influence only the rate of pacemaker implantation and not the incidence of new LBBB. Further data is required to clarify the impact of valve design on conduction abnormalities.

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NOVEL PREDICTORS OF PERSISTENT LEFT BUNDLE BRANCH BLOCK AND PERMANENT PACEMAKER IMPLANTATION AFTER EDWARDS SAPIEN 3 TAVR

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(19)31853-4 ◽

2019 ◽

Vol 73 (9) ◽

pp. 1246

Author(s):

Syed Zaid ◽

Miriam Brinkert ◽

Hasan Ahmad ◽

Ryan Kaple ◽

Cenap Undemir ◽

...

Keyword(s):

Left Bundle Branch Block ◽

Pacemaker Implantation ◽

Permanent Pacemaker ◽

Bundle Branch Block ◽

Permanent Pacemaker Implantation ◽

Edwards Sapien ◽

Sapien 3

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CLINICAL IMPACT OF PERSISTENT LEFT BUNDLE BRANCH BLOCK AND PERMANENT PACEMAKER IMPLANTATION AFTER TRANSCATHETER AORTIC VALVE REPLACEMENT ON LEFT VENTICULAR FUNCTION

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(14)61961-6 ◽

2014 ◽

Vol 63 (12) ◽

pp. A1958

Author(s):

Fnu Abhishek ◽

Edwin Heist ◽

Sammy Elmariah ◽

Jonathan Passeri ◽

Igor Palacios ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Left Bundle Branch Block ◽

Transcatheter Aortic Valve Replacement ◽

Pacemaker Implantation ◽

Permanent Pacemaker ◽

Clinical Impact ◽

Bundle Branch Block ◽

Transcatheter Aortic Valve

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Delayed occurrence of an accelerated idioventricular rhythm with alternating bundle branch block after myocardial infarction as predictor of sudden cardiac arrest: a case report

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytaa378 ◽

2020 ◽

Author(s):

Markus Bettin ◽

Matthias Koopmann ◽

Gerold Mönnig ◽

Christian Pott

Keyword(s):

Myocardial Infarction ◽

Cardiac Arrest ◽

Sudden Cardiac Death ◽

Cardiac Death ◽

Sudden Cardiac Arrest ◽

Pacemaker Implantation ◽

Permanent Pacemaker ◽

Bundle Branch Block ◽

Permanent Pacemaker Implantation ◽

Idioventricular Rhythm

Abstract Background Accelerated idioventricular rhythm (AIVR) is known as reperfusion arrhythmia in the setting of acute myocardial infarction (AMI). In healthy individuals, it is usually considered to be benign. Alternating bundle branch block (ABBB) often progresses to complete atrioventricular block requiring permanent pacemaker implantation. We report a case of delayed appearance of AIVR following myocardial infarction (MI) in combination with ABBB as precursor of sudden cardiac arrest due to ventricular fibrillation (VF). Case summary A 62-year-old male with pre-existing left bundle branch block (LBBB) was admitted with an acute non-ST segment elevation MI. He underwent successful percutaneous coronary intervention (PCI) of a subtotal proximal left anterior descending artery (LAD) stenosis. Before and after PCI the electrocardiogram (ECG) demonstrated sinus rhythm with LBBB. The patient was discharged 5 days after PCI, left ventricular function at this time was moderately reduced (ejection fraction of 40%). After another 5 days, the patient was admitted for elective cardiac rehabilitation. At this time, the ECG demonstrated an AIVR with right bundle branch block morphology. Due to ABBB, the patient was scheduled for permanent pacemaker implantation. Before pacemaker implantation could take place, the patient developed a sudden cardiac arrest due to VF and was successfully resuscitated. A follow-up coronary angiography revealed no novel lesions. A cardiac resynchronization therapy defibrillator was implanted for secondary prevention of sudden cardiac death. Discussion Delayed occurrence of AIVR in combination with ABBB following AMI could be a predictor of sudden cardiac death. These patients are probably at high risk for malignant ventricular arrhythmias.

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