Guillem Muntané-Carol1, Marina Urena2, Luis Nombela-Franco3, Ignacio Amat-Santos4, Neal Kleiman5, Antonio Munoz-Garcia6, Felipe Atienza7, Vicenç Serra8, Marc W Deyell9, Gabriela Veiga-Fernandez10, Jean-Bernard Masson11, Victoria Canadas-Godoy3, Dominique Himbert2, Javier Castrodeza4, Jaime Elizaga7, Jaume Francisco Pascual8, John G Webb9, Jose M de la Torre Hernandez10, Lluis Asmarats1, Emilie Pelletier-Beaumont1, Francois Philippon1, Josep Rodés-Cabau1. 1. Department of Cardiology, Quebec Heart & Lung Institute, Laval University, 2725 Ch Ste-Foy, Quebec City, G1V 4G5, Quebec, Canada. 2. Department of Cardiology, Assistance Publique-Hôpitaux de Paris, Höpital Bichat-Claude Bernard, Paris, France. 3. Department of Cardiology, Instituto Cardiovascular, Hospital Clinico San Carlos, IdISSC, Madrid, Spain. 4. Department of Cardiology, Hospital Universitario de Valladolid, Valladolid, Spain. 5. Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, USA. 6. Department of Cardiology, Hospital Virgen de la Victoria, Málaga, Spain. 7. Department of Cardiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain. 8. Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain. 9. Division of Cardiology and Centre for Cardiovascular Innovation, University of British Columbia, St Paul's hospital, Vancouver, British Columbia, Canada. 10. Department of Cardiology, Hospital Marques de Valdecilla, Santander, Spain. 11. Department of Cardiology, Centre Hospitalier Universitaire de Montreal, Montreal, Quebec, Canada.
Abstract
AIMS: We determined the incidence and type of arrhythmias at 2-year follow-up in patients with new-onset persistent left bundle branch block (LBBB) following transcatheter aortic valve replacement (TAVR). METHODS AND RESULTS: Multicentre prospective study including 103 consecutive patients with new-onset persistent LBBB post-TAVR (SAPIEN XT/3: 53; CoreValve/Evolut R: 50). An implantable cardiac monitor (Reveal XT, Reveal Linq) was implanted before hospital discharge and patients had continuous monitoring for up to 2 years. Arrhythmic events were adjudicated in a central core lab. 1836 new arrhythmic events (tachyarrhythmias: 1655 and bradyarrhythmias: 181) occurred at 2 years. Of these, 283 (15%) occurred beyond 1 year (tachyarrhythmias 212, bradyarrhythmias 71) in 33 (36%) patients, without differences between valve type. Most late (>1 year) arrhythmic events were asymptomatic (94%) and led to a treatment change in 17 (19%) patients. A total of 71 late bradyarrhythmias [high-degree atrioventricular block (HAVB): 3, severe bradycardia: 68] were detected in 17 (21%) patients. At 2 years, 18 (17%) patients had received a permanent pacemaker (PPM) or implantable cardiac-defibrillator. PPM implantation due to HAVB predominated in the early phase post-TAVR, with only 1 HAVB event requiring PPM implantation after 1 year. CONCLUSION: Patients with new-onset LBBB post-TAVR exhibited a very high burden of arrhythmic events within the 2 years post-procedure. While new tachyarrhythmic events were homogeneously distributed over time, the vast majority of new HAVB episodes leading to PPM implantation occurred early after the procedure. These results should help to guide the management of this challenging group of patients. (clinicaltrials.gov: NCT02153307). Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: We determined the incidence and type of arrhythmias at 2-year follow-up in patients with new-onset persistent left bundle branch block (LBBB) following transcatheter aortic valve replacement (TAVR). METHODS AND RESULTS: Multicentre prospective study including 103 consecutive patients with new-onset persistent LBBB post-TAVR (SAPIEN XT/3: 53; CoreValve/Evolut R: 50). An implantable cardiac monitor (Reveal XT, Reveal Linq) was implanted before hospital discharge and patients had continuous monitoring for up to 2 years. Arrhythmic events were adjudicated in a central core lab. 1836 new arrhythmic events (tachyarrhythmias: 1655 and bradyarrhythmias: 181) occurred at 2 years. Of these, 283 (15%) occurred beyond 1 year (tachyarrhythmias 212, bradyarrhythmias 71) in 33 (36%) patients, without differences between valve type. Most late (>1 year) arrhythmic events were asymptomatic (94%) and led to a treatment change in 17 (19%) patients. A total of 71 late bradyarrhythmias [high-degree atrioventricular block (HAVB): 3, severe bradycardia: 68] were detected in 17 (21%) patients. At 2 years, 18 (17%) patients had received a permanent pacemaker (PPM) or implantable cardiac-defibrillator. PPM implantation due to HAVB predominated in the early phase post-TAVR, with only 1 HAVB event requiring PPM implantation after 1 year. CONCLUSION: Patients with new-onset LBBB post-TAVR exhibited a very high burden of arrhythmic events within the 2 years post-procedure. While new tachyarrhythmic events were homogeneously distributed over time, the vast majority of new HAVB episodes leading to PPM implantation occurred early after the procedure. These results should help to guide the management of this challenging group of patients. (clinicaltrials.gov: NCT02153307). Published on behalf of the European Society of Cardiology. All rights reserved.