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Late arrhythmias in patients with new-onset persistent left bundle branch block after transcatheter aortic valve

Guillem Muntané-Carol1, Luis Nombela-Franco2, Vicenç Serra3

  • 1Department of Cardiology, Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada.

Heart Rhythm
|June 3, 2021
PubMed

Insights

Patients undergoing TAVR with the SAPIEN 3 valve who develop new left bundle branch block (LBBB) experience a high burden of arrhythmias. Over one-third had significant events, with half occurring within four weeks post-discharge.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiac Electrophysiology

Background:

  • The incidence of arrhythmias after transcatheter aortic valve replacement (TAVR) in patients with new-onset left bundle branch block (LBBB) using the SAPIEN 3 (S3) valve is not well understood.
  • New-onset LBBB is a known complication following TAVR, potentially leading to cardiac rhythm disturbances.

Purpose of the Study:

  • To investigate the frequency of late-onset arrhythmias in patients who develop new-onset LBBB after TAVR with the S3 valve.
  • To assess the clinical significance and management implications of these arrhythmias.

Main Methods:

  • A prospective, multicenter study enrolled 104 patients with new-onset persistent LBBB post-TAVR with the S3 valve.
  • Implantable cardiac monitors were used to track arrhythmias before discharge.
  • The primary endpoint was the occurrence of high-degree atrioventricular block or complete heart block (HAVB/CHB).

Main Results:

  • 38.5% of patients experienced at least one significant arrhythmic event, necessitating treatment changes in 42.5% of those affected.
  • Significant bradyarrhythmias, including HAVB/CHB, occurred in 19.2% of patients, with 50% of these experiencing HAVB/CHB.
  • Most significant bradyarrhythmias (60%) were detected within four weeks of hospital discharge, and 8.7% of patients required permanent pacemaker implantation within 12 months.

Conclusions:

  • Patients receiving the S3 valve for TAVR who develop new-onset LBBB face a substantial risk of arrhythmias, with 10% experiencing HAVB/CHB.
  • The early post-discharge period (within 4 weeks) is critical for monitoring bradyarrhythmic events.
  • Findings support the consideration of continuous electrocardiographic monitoring for TAVR patients with new conduction disturbances post-procedure.
Abstract

Keywords:
Atrial fibrillationBradyarrhythmiaLeft bundle branch blockPacemaker implantationSAPIEN 3Transcatheter aortic valve replacement

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