title: Incidence and predictors of left bundle branch block after transcatheter aortic valve implantation.
abstract: OBJECTIVE
  The 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.
  
  
  METHODS
  154 consecutive patients (53 male, mean age 81 ± 7 years) 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.
  
  
  METHODS
  Preprocedural 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).
  
  
  CONCLUSIONS
  TAVI 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.
authors: Medical Clinic I, University RWTH Aachen, Germany.
authors: Ömer
authors: Ö
authors: Aktug
authors: Guido
authors: G
authors: Dohmen
authors: Kathrin
authors: K
authors: Brehmer
authors: Ralph
authors: R
authors: Koos
authors: Ertunc
authors: E
authors: Altiok
authors: Verena
authors: V
authors: Deserno
authors: Ralf
authors: R
authors: Herpertz
authors: Rüdiger
authors: R
authors: Autschbach
authors: Nikolaus
authors: N
authors: Marx
authors: Rainer
authors: R
authors: Hoffmann
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000401:mortality / Q000601:surgery*; D002037:Bundle-Branch Block / Q000453:epidemiology / Q000209:etiology*; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000379:methods*; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000401:mortality; D006801:Humans; D015994:Incidence; D008297:Male; D010138:Pacemaker, Artificial; D012307:Risk Factors; D015996:Survival Rate; D014057:Tomography, X-Ray Computed