Incidence of infranodal conduction delay in patients with left bundle branch block after transcatheter aortic valve replacement: Impact of the 2021 ESC guidelines for cardiac pacing

Abstract

The occurrence of left bundle branch block (LBBB) after transcatheter aortic valve replacement (TAVR) remains the most frequent complication of the procedure. 1 Khatri P.J. Webb J.G. Rodés-Cabau J. et al. Adverse effects associated with transcatheter aortic valve implantation: a meta-analysis of contemporary studies. Ann Intern Med. 2013; 158: 35-46 Crossref PubMed Scopus (210) Google Scholar ,2 Badertscher P. Knecht S. Zeljković I. et al. Management of conduction disorders after transcatheter aortic valve implantation: results of the EHRA survey. Europace. 2022; 24: 1179-1185 Crossref PubMed Scopus (0) Google Scholar Electrophysiological (EP) testing is recommended with a class IIa indication in the new 2021 European Society of Cardiology (ESC) guidelines for cardiac pacing 3 Glikson M. Nielsen J.C. Kronborg M.B. et al. 2021 ESC guidelines on cardiac pacing and cardiac resynchronization therapy. Eur Heart J. 2021; 42: 3427-3520 Crossref PubMed Scopus (384) Google Scholar in patients having new LBBB with QRS ≥150 ms or PR ≥240 ms or with pre-existing LBBB with a delta of QRS/PR intervals ≥20 ms after TAVR. A cutoff for HV interval ≥70 ms to consider pacemaker (PM) implantation was suggested. However, evidence for these proposed cutoffs of HV interval, QRS duration, and PR interval is scarce in LBBB patients after TAVR. 4 Jørgensen T.H. de Backer O. Gerds T.A. et al. Immediate post-procedural 12-lead electrocardiography as predictor of late conduction defects after transcatheter aortic valve replacement. JACC Cardiovasc Interv. 2018; 11: 1509-1518 Crossref PubMed Scopus (44) Google Scholar