title: Comparison of incidence and predictors of left bundle branch block after transcatheter aortic valve implantation using the CoreValve versus the Edwards valve.
abstract: Conduction disorders and permanent pacemaker implantation are common complications in patients who undergo transcatheter aortic valve implantation (TAVI). The aim of this study was to assess the incidence and clinical significance of new bundle branch block in patients who underwent TAVI with the Medtronic CoreValve Revalving System (MCRS) or the Edwards SAPIEN valve (ESV). Data from 238 patients with no previous pacemaker implantation, left bundle branch block (LBBB) or right bundle branch block at baseline electrocardiography who underwent TAVI with either MCRS (n = 87) or ESV (n = 151) bioprostheses from 2007 to 2011 were analyzed. New-onset LBBB occurred in 26.5% patients (n = 63): 13.5% with the ESV (n = 20) and 50.0% with the MCRS (n = 43) (p = 0.001). Permanent pacemaker implantation was required in 12.7% of patients (n = 8) because of complete atrioventricular block (ESV n = 2, MCRS n = 4), LBBB and first degree atrioventricular block (MCRS n = 1) and new-onset LBBB associated with sinus bradycardia (MCRS n = 1). At discharge, LBBB persisted in 8.6% of ESV patients (n = 13) and 32.2% of MCRS patients (n = 28) (p = 0.001). On multivariate analysis, the only predictor of LBBB was MCRS use (odds ratio 7.2, 95% confidence interval 2.9 to 17.4, p <0.001). Persistent new-onset LBBB at discharge was not associated with overall (log-rank p = 0.42) or cardiovascular (log-rank p = 0.46) mortality. New-onset right bundle branch block was documented in 4.6% of patients (n = 11), with no statistically significant differences between the ESV and MCRS. In conclusion, new-onset LBBB is a frequent intraventricular conduction disturbance after TAVI with a higher incidence with the MCRS compared with the ESV. LBBB persists in most patients, but in this cohort, it was not a predictor of overall or cardiovascular mortality or permanent pacemaker implantation.
authors.affiliation: Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Irene
authors.initials: I
authors.lastname: Franzoni
authors.forename: Azeem
authors.initials: A
authors.lastname: Latib
authors.forename: Francesco
authors.initials: F
authors.lastname: Maisano
authors.forename: Charis
authors.initials: C
authors.lastname: Costopoulos
authors.forename: Luca
authors.initials: L
authors.lastname: Testa
authors.forename: Filippo
authors.initials: F
authors.lastname: Figini
authors.forename: Francesco
authors.initials: F
authors.lastname: Giannini
authors.forename: Sandeep
authors.initials: S
authors.lastname: Basavarajaiah
authors.forename: Marco
authors.initials: M
authors.lastname: Mussardo
authors.forename: Massimo
authors.initials: M
authors.lastname: Slavich
authors.forename: Maurizio
authors.initials: M
authors.lastname: Taramasso
authors.forename: Micaela
authors.initials: M
authors.lastname: Cioni
authors.forename: Matteo
authors.initials: M
authors.lastname: Longoni
authors.forename: Santo
authors.initials: S
authors.lastname: Ferrarello
authors.forename: Andrea
authors.initials: A
authors.lastname: Radinovic
authors.forename: Simone
authors.initials: S
authors.lastname: Sala
authors.forename: Silvia
authors.initials: S
authors.lastname: Ajello
authors.forename: Alessandro
authors.initials: A
authors.lastname: Sticchi
authors.forename: Manuela
authors.initials: M
authors.lastname: Giglio
authors.forename: Eustachio
authors.initials: E
authors.lastname: Agricola
authors.forename: Alaide
authors.initials: A
authors.lastname: Chieffo
authors.forename: Matteo
authors.initials: M
authors.lastname: Montorfano
authors.forename: Ottavio
authors.initials: O
authors.lastname: Alfieri
authors.forename: Antonio
authors.initials: A
authors.lastname: Colombo
mesh_terms: D000368:Aged; D001021:Aortic Valve / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000601:surgery*; D001919:Bradycardia / Q000453:epidemiology / Q000209:etiology; D002037:Bundle-Branch Block / Q000453:epidemiology / Q000209:etiology*; D006328:Cardiac Catheterization; D016009:Chi-Square Distribution; D004562:Electrocardiography; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D011237:Predictive Value of Tests; D016896:Treatment Outcome