Occurrence of high-grade conduction disorder after the onset of left bundle branch block in post-TAVI. The French multicenter LBBB-TAVI study

Abstract

Transcatheter aortic valve implantation (TAVI) has revolutionized the management of severe aortic stenosis. The development of a new-onset complete left bundle branch block (LBBB) is, however, a frequent complication. The objective of the present study was to assess the impact of a new-onset LBBB after TAVI on the risk of high degree conduction disorder appearance. Patients were included in 10 centers in the French Multicenter LBBB-TAVI study. New-onset LBBB after TAVI persisting for more than 24 hours were stratified by intracardiac electrophysiological study. Patients at high-risk of conduction disturbances (≥ 70 ms His-ventricle interval (HV) or presence of infra-Hissian block) were implanted with a pacemaker with recording of disturbance episodes (Sorin Microport CRM, Clamart, France). Those at lower risk (HV < 70 ms) were implanted with a loop recorder with automatic remote monitoring (Biotronik, Berlin, Germany). The primary end point was the incidence (rate and time to onset) of high-grade conduction disturbances between the two groups at 12 months. From June 2015 to November 2018, 199 patients were included in the study (mean age 82.3 ± 5.9 years, 61.9% female sex). A self-expanding valve was implanted in 65.2% of the procedures. A pacemaker were implanted in 46 patients, 135 patients with a loop recorder. At 12 months, 46 (25.4%) patients displayed a high-grade conduction disorder. High-grade conduction disturbances were more frequent with HV ≥ 70 ms (46.2% vs. 17.1%, P < 0.001). The median time to conduction disorder occurrence was 100 [29–229] days. In multivariate analysis, adjusted for implantation center, an HV ≥ 70 ms was independently associated with the occurrence of a high-grade conduction disorder, HR 2.8 [1.3–6.1], P = 0.007 ( Fig. 1 ). Increased HV interval (≥ 70 ms) is independently associated with the occurrence of high-grade conduction disorder in new-onset LBBB after TAVI.