title: Occurrence, fate and consequences of ventricular conduction abnormalities after transcatheter aortic valve implantation.
abstract: OBJECTIVE
  Transcatheter aortic valve implantation (TAVI) is frequently complicated by new left bundle branch block (LBBB). We investigated the development and persistence of LBBB during follow-up and its clinical consequences.
  
  
  RESULTS
  ECGs at baseline, within 24 hours, before discharge and at 12 months after TAVI were assessed in 476 patients without pre-existing LBBB and/or pacemaker before or after TAVI. TAVI-induced new LBBB was categorised based on the timing of the occurrence (within 24 hours [acute], after 24 hours but before discharge [subacute], and after discharge [late]), in addition to persistence (transient or persistent). A total of 175 patients (36.8%) developed new LBBB of which 85.7% occurred within 24 hours after TAVI, 12.0% before and 2.3% after hospital discharge, and was persistent in 111 patients (63.4%). Implantation of the Medtronic CoreValve System (MCS) more frequently led to new LBBB than the balloon-expandable Edwards SAPIEN valve (ES) (53.8% versus 21.7%) with less recovery during follow-up (39.0% versus 9.5%). Late new LBBB was only seen in four patients (0.8%). During a median follow-up of 915 (578-1,234) days, persistent LBBB was associated with a significant increase in mortality as compared to no LBBB and temporary LBBB combined (hazard ratio 1.49, 95% confidence interval, 1.10-2.03; p=0.01).
  
  
  CONCLUSIONS
  TAVI-induced new LBBB occurs in almost 40% of patients, almost all before hospital discharge. It occurs three times more frequently after MCS than after ES valve implantation and has a twofold lower tendency to resolve during follow-up. Persistent LBBB is associated with a higher mortality.
authors.affiliation: Catharina Hospital, Eindhoven, The Netherlands.
authors.forename: Patrick
authors.initials: P
authors.lastname: Houthuizen
authors.forename: Robert M A
authors.initials: RM
authors.lastname: van der Boon
authors.forename: M
authors.initials: M
authors.lastname: Urena
authors.forename: N
authors.initials: N
authors.lastname: Van Mieghem
authors.forename: Guus B R
authors.initials: GB
authors.lastname: Brueren
authors.forename: Thomas T
authors.initials: TT
authors.lastname: Poels
authors.forename: Leen A F M
authors.initials: LA
authors.lastname: Van Garsse
authors.forename: Josep
authors.initials: J
authors.lastname: Rodés-Cabau
authors.forename: Frits W
authors.initials: FW
authors.lastname: Prinzen
authors.forename: Peter
authors.initials: P
authors.lastname: de Jaegere
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000601:surgery*; D002037:Bundle-Branch Block / Q000175:diagnosis* / Q000453:epidemiology* / Q000401:mortality; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000379:methods; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D015994:Incidence; D008297:Male; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome