Incidence and predictors of left bundle branch block after transcatheter aortic valve implantation

Abstract

ObjectiveThe aim of this study was to evaluate the frequency and predictors of left bundle branch block (LBBB) after Transcatheter Aortic Valve Implantation (TAVI) using CoreValve and Edwards SAPIEN prosthesis. Methods154 consecutive patients (53 male, mean age 81±7years) with severe symptomatic aortic stenosis underwent TAVI. Transfemoral AVI (CoreValve) was performed in 72 patients (47%). Transapical AVI (Edwards SAPIEN valve) was done with in n=82 patients (53%). Patient characteristics, valvular and left ventricular outflow tract geometry from pre- and postprocedural imaging (computed tomography, transesophageal echocardiography and callipered angiography) and procedural characteristics were evaluated to define predictors of new LBBB after TAVI. PatientsPreprocedural LBBB was present in 15 patients (n=5 CoreValve, n=10 in Edwards SAPIEN). In 40 of 139 patients (29%) a new LBBB was observed after TAVI. The frequency of new LBBB was higher with CoreValve n=27 (38%) than with Edwards SAPIEN implantation n=13 (16%; p=0.006). Patients with new LBBB had larger valve implantation depth into the left ventricular outflow tract (9.0±2.9 vs. 4.4±2.5mm, p<0.001). In 18 of 40 patients (45%) the new LBBB was persistent at 30days. Predictors of new LBBB were prosthesis implantation depth into the left ventricular outflow tract (OR=1.185 95% CI 1.064–1.320 per additional mm implantation depth; p=0.002) and use of CoreValve prosthesis (OR=2.639 95% CI 1.314–5.813; p=0.007). ConclusionTAVI is frequently associated with new LBBB. There is a higher frequency of persistent LBBB with the CoreValve system. Implantation depth is a critical factor for the development of new LBBB.