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Upper-extremity Approach for Secondary Access in Transfemoral Transcatheter Aortic Valve Implantation
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Upper-extremity Approach for Secondary Access in Transfemoral Transcatheter Aortic Valve Implantation

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Incidence of strict versus nonstrict left bundle branch block after transcatheter aortic valve replacement

Frida Sundh1, Jacob Simlund1, John Kevin Harrison2

  • 1Department of Clinical Physiology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden; Duke Clinical Research Institute, Durham, NC.

American Heart Journal
|March 3, 2015
PubMed

Insights

Transcatheter aortic valve replacement (TAVR) frequently causes strict left bundle branch block (LBBB), likely due to procedural injury. Preprocedure QRS duration does not predict strict LBBB development after TAVR.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiac Electrophysiology

Background:

  • Conventional electrocardiogram (ECG) criteria misdiagnose up to one-third of left bundle branch block (LBBB) cases.
  • Strict LBBB is associated with reduced left ventricular pumping efficiency compared to nonstrict LBBB.
  • The frequency of strict LBBB post-transcatheter aortic valve replacement (TAVR) remains unevaluated.

Purpose of the Study:

  • To determine the incidence of strict versus nonstrict LBBB after TAVR.
  • To test if preprocedure QRS duration predicts strict LBBB development.
  • To test if preprocedure QRS duration predicts nonstrict LBBB development.

Main Methods:

  • Included 71 patients undergoing TAVR without pre-existing bundle branch block or pacemaker.
  • Acquired 12-lead ECGs preprocedure, and at 1-day and 1-month postprocedure.
  • Classified all ECGs as strict LBBB, nonstrict LBBB, or no LBBB.

Main Results:

  • 25 (37%) of 68 analyzed patients developed strict LBBB on post-TAVR day 1; 2 (3%) developed nonstrict LBBB.
  • At 1-month, nonstrict LBBB resolved in both patients; 20% of strict LBBB cases resolved.
  • Preprocedure QRS duration did not predict strict LBBB (P = .51).

Conclusions:

  • Most LBBB cases post-TAVR meet strict criteria, suggesting probable left bundle branch injury.
  • Preprocedural QRS duration does not predict the development of strict LBBB after TAVR.
Abstract

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