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. 2020 Mar 3;9(5):e014446.
doi: 10.1161/JAHA.119.014446. Epub 2020 Feb 22.

Electrophysiology Testing to Stratify Patients With Left Bundle Branch Block After Transcatheter Aortic Valve Implantation

Sven Knecht  1   2 , Beat Schaer  1   2 , Tobias Reichlin  1   2   3 , Florian Spies  1   2 , Antonio Madaffari  1   2 , Annina Vischer  4 , Gregor Fahrni  1   2 , Raban Jeger  1   2 , Christoph Kaiser  1   2 , Stefan Osswald  1   2 , Christian Sticherling  1   2 , Michael Kühne  1   2
Affiliations

Electrophysiology Testing to Stratify Patients With Left Bundle Branch Block After Transcatheter Aortic Valve Implantation

Sven Knecht et al. J Am Heart Assoc. .

Abstract

Background Left bundle branch block (LBBB) is common after transcatheter aortic valve implantation (TAVI) and is an indicator of subsequent high-grade atrioventricular block (HAVB). No standardized protocol is available to identify LBBB patients at risk for HAVB. The aim of the current study was to evaluate the safety and efficacy of an electrophysiology study tailored strategy in patients with LBBB after TAVI. Methods and Results We prospectively analyzed consecutive patients with LBBB after TAVI. An electrophysiology study was performed to measure the HV-interval the day following TAVI. In patients with normal His-ventricular (HV)-interval ≤55 ms, a loop recorder was implanted (ILR-group), whereas pacemaker implantation was performed in patients with prolonged HV-interval >55 ms (PM-group). The primary end point was occurrence of HAVB during a follow-up of 12 months. Secondary end points were symptoms, hospitalizations, adverse events because of device implantation or electrophysiology study, and death. Of 373 patients screened after TAVI, 56 patients (82±6 years, 41% male) with LBBB were included. HAVB occurred in 4 of 41 patients (10%) in the ILR-group and in 8 of 15 patients (53%) in the PM-group (P<0.001). We did not identify other predictors for HAVB than the HV interval. The negative predictive value for the cut-off of HV 55 ms to detect HAVB was 90%. No HAVB-related syncope occurred in the 2 groups. Conclusions An electrophysiology study tailored strategy to LBBB after TAVI with a cut-off of HV >55 ms is a feasible and safe approach to stratify patients with regard to developing HAVB during a follow-up of 12 months.

Keywords: electrophysiology study; high‐grade AV block; left bundle branch block; transaortic valve implantation.

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Figures

Figure 1
Figure 1
Flow chart of the total cohort. AVB indicates atrioventricular block; HV, His‐Ventricular; LBBB, left bundle branch block; PM, pacemaker.
Figure 2
Figure 2
Receiver‐operating characteristics curve demonstrating the accuracy of His‐Ventricular measurement for high‐grade atrioventricular block. AUC indicates area under the curve.
See this image and copyright information in PMC

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