Clinical Impact of Persistent Left Bundle-Branch Block After Transcatheter Aortic Valve Implantation With CoreValve Revalving System

Testa, Luca; Latib, Azeem; Marco, Federico De; Agnifili, Mauro; Latini, Roberto; Petronio, Anna Sonia; Ettori, Federica; Poli, Arnaldo; Servi, Stefano De; Ramondo, Angelo; Napodano, Massimo; Klugmann, Silvio; Tamburino, Corrado; Brambilla, Nedy; Colombo, Antonio; Bedogni, Francesco

doi:10.1161/circulationaha.112.001099

Cited by 143 publications

(87 citation statements)

References 27 publications

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“…The diagnosis criteria for LBBB were based on the recommendations from the American Heart Association/American College of Cardiology Foundation/Heart Rhythm Society 20 in 4 studies 3,4,13,18 and from the World Health Organizational/International Society and Federation for Cardiology 21 in 2 studies. 11,19 One study 12 did not detail the diagnosis criteria. The study-selection process is shown in Figure 1.…”

Section: Search Resultsmentioning

confidence: 99%

“…However, Urena et al and Testa et al reported no association between NOP-LBBB and HF admission. 13,19 This may be due to the uncertain permanency of NOP-LBBB.…”

Section: Permanent Pacemaker Implantation In New-onset Persistent Lefmentioning

confidence: 99%

“…3 Testa et al reported similar LBBB rates at discharge and 30 days after TAVI. 19 The lack of data regarding the natural course of NOP-LBBB may be one of the reasons for inconsistent results of mortality. Results of the study by Houthuizen et al showed a significant increase in mortality in the NOP-LBBB group, when NOP-LBBB was defined as LBBB persisting during 1-year follow-up.…”

Section: New-onset Persistent Left Bundle Branch Block and Mortalitymentioning

confidence: 99%

“…However, limited data suggest that a high proportion of NOP-LBBB patients will remain in LBBB. 3,19 Second, most of the studies reported 1-year (not beyond) mortality. The study by Houthizen et al had the longest follow-up duration among included studies and revealed increased mortality in NOP-LBBB patients.…”

Section: New-onset Persistent Left Bundle Branch Block and Mortalitymentioning

confidence: 99%

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The Prognostic Impact of New‐Onset Persistent Left Bundle Branch Block Following Transcatheter Aortic Valve Implantation: A Meta‐analysis

Ando

Takagi

2016

Clinical Cardiology

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New-onset persistent left bundle branch block (NOP-LBBB) is one of the most common conduction disturbances after transcatheter aortic valve implantation (TAVI). We hypothesized that NOP-LBBB may have a clinically negative impact after TAVI. To find out, we conducted a systematic literature search of the MEDLINE/PubMed and Embase databases. Observational studies that reported clinical outcomes of NOP-LBBB patients after TAVI were included. The random-effects model was used to combine odds ratios, risk ratios, or hazard ratios (HRs) with 95% confidence intervals. Adjusted HRs were utilized over unadjusted HRs or risk ratios when available. A total of 4049 patients (807 and 3242 patients with and without NOP-LBBB, respectively) were included. Perioperative (in-hospital or 30-day) and midterm all-cause mortality and midterm cardiovascular mortality were comparable between the groups. The NOP-LBBB patients experienced a higher rate of permanent pacemaker implantation (HR: 2.09, 95% confidence interval: 1.12-3.90, P = 0.021, I 2 = 83%) during midterm follow-up. We found that NOP-LBBB after TAVI resulted in higher permanent pacemaker implantation but did not negatively affect the midterm prognosis. Therefore, careful observation during the follow-up is required.

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Section: Search Resultsmentioning

confidence: 99%

“…However, Urena et al and Testa et al reported no association between NOP-LBBB and HF admission. 13,19 This may be due to the uncertain permanency of NOP-LBBB.…”

Section: Permanent Pacemaker Implantation In New-onset Persistent Lefmentioning

confidence: 99%

Section: New-onset Persistent Left Bundle Branch Block and Mortalitymentioning

confidence: 99%

Section: New-onset Persistent Left Bundle Branch Block and Mortalitymentioning

confidence: 99%

See 2 more Smart Citations

The Prognostic Impact of New‐Onset Persistent Left Bundle Branch Block Following Transcatheter Aortic Valve Implantation: A Meta‐analysis

Ando

Takagi

2016

Clinical Cardiology

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“…21 Smaller case series have demonstrated an increase in syncopal events and PPM insertion in patients with persistent LBBB and may be related to the progression of LBBB toward CHB described above. 22,23 Previously, TAVR has been shown to improve or maintain left ventricular function (LVF), especially among patients with baseline depressed ejection fraction. 24 In those with persistent LBBB, however, there is greater propensity for LV dyssynchrony and failure of LV ejection fraction to recover at one year.…”

Section: Significance Of Lbbbmentioning

confidence: 99%

Mechanisms of Heart Block after Transcatheter Aortic Valve Replacement – Cardiac Anatomy, Clinical Predictors and Mechanical Factors that Contribute to Permanent Pacemaker Implantation

Lee¹,

Yeshwant²,

Chava³

et al. 2015

Arrhythmia &Amp; Electrophysiology Review

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Aortic stenosis (AS) is the most common valvular heart disease in industrialised countries with a prevalence of about 5 % in the general population aged greater than 75 years. During the past decade, transcatheter aortic valve replacement (TAVR) has emerged as a valuable, minimally invasive treatment option for patients presenting with symptomatic severe AS, who due to their advanced age and relevant comorbidities are at prohibitive risk for conventional surgery, 1 whereas surgical aortic valve replacement (SAVR) remains the gold standard for the treatment of symptomatic AS in patients with low to moderate surgical risk.2 However, many patients begin to experience AS-related symptoms late in their lives when multiple comorbidities preclude surgery as an option. As a result, before the advent of TAVR, patients considered high-or extreme-risk surgical candidates were once limited to conventional medical therapy. Ever since the first device was deployed in 2002, TAVR has enabled inoperable patients the opportunity to experience survival rates equivalent to their surgical counterparts with considerably less procedural risk.1 Therefore, the number of patients undergoing TAVR has increased steadily, and the complications related to valve implantation have been well defined.The development of atrioventricular (AV) conduction disturbances is one of the most commonly encountered complications associated with TAVR. Between 3 and 6 % of patients undergoing surgical replacement of their aortic valve will develop complete heart block (CHB), 3 while considerably higher rates have been reported in the setting of TAVR in individual studies. 4 In this review, we aim to explore the significance of conduction disturbances preceding and resulting from TAVR. We have focused on data that raise concerns around creating chronic left ventricular (LV) dyssynchrony in this patient population, either as a consequence of creating left bundle branch block (LBBB), or from chronic right ventricular (RV) pacing. Additionally, we reviewed a number of factors that predispose TAVR patients to develop conduction disturbances, and clinical factors that can be used to identify those patients likely to require permanent pacing and alternatively those in whom it may be worth waiting longer prior to committing to permanent pacemaker (PPM) implantation. Shy of unique valve designs, it has become clear there are only modest improvements an operator can make to avoid the complication of heart block and this complication is simply part of the procedure. It is critical to anticipate it and think prospectively about the ideal pacing mode for the individual patient to prevent chronic LV dyssynchrony in those patients at highest risk. Mechanisms of Heart Block Anatomical Relationship of the Cardiac Conduction System and the Aortic RootSince the 16th century when Leonardo da Vinci conducted the first known cadaveric studies of the heart, the aortic root complex has been studied extensively. With the advent of percutaneous valves, there has been renewed interest ...

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Trends in the occurrence of new conduction abnormalities after transcatheter aortic valve implantation

Boon

Houthuizen

Ureña

et al. 2014

Cathet Cardio Intervent

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Over time the frequency of LBBB after TAVI decreased significantly, especially in patients undergoing TAVI with the MCS. Experience and the subsequent reduction in depth of implantation seem responsible for this reduction. Contrary to TAVI-LBBB, the incidence of PPI remained unchanged over time and was not affected by experience. Although experience has led to a decrease in new CAs after TAVI, elucidation of pathophysiologic mechanisms underlying these CAs and subsequent changes in patient stratification, valve design and the procedure are needed to further reduce this complication.

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Clinical Impact of Persistent Left Bundle-Branch Block After Transcatheter Aortic Valve Implantation With CoreValve Revalving System

Cited by 143 publications

References 27 publications

The Prognostic Impact of New‐Onset Persistent Left Bundle Branch Block Following Transcatheter Aortic Valve Implantation: A Meta‐analysis

The Prognostic Impact of New‐Onset Persistent Left Bundle Branch Block Following Transcatheter Aortic Valve Implantation: A Meta‐analysis

Mechanisms of Heart Block after Transcatheter Aortic Valve Replacement – Cardiac Anatomy, Clinical Predictors and Mechanical Factors that Contribute to Permanent Pacemaker Implantation

Trends in the occurrence of new conduction abnormalities after transcatheter aortic valve implantation

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