title: Predictive factor and clinical consequence of left bundle-branch block after a transcatheter aortic valve implantation.
abstract: BACKGROUND
  Atrioventricular conduction disturbances can develop after transcatherter aortic valve implantations (TAVIs) with balloon-expandable valves because the conduction system exists adjacent to the aortic valve. However, the clinical consequence of patients with new onset conduction disturbances is not clear.
  
  
  OBJECTIVE
  This study aimed to assess the incidence and progress of new-onset conduction disturbances following TAVIs and the cardiac function evaluated by echocardiography.
  
  
  METHODS
  This study consisted of 90 consecutive patients that underwent TAVIs with Edwards SAPIEN XT valves in a single center. Atrioventricular conduction system disturbances were assessed by electrocardiography and echocardiography up to 6months post TAVI.
  
  
  RESULTS
  Twenty patients (22%) developed new onset complete left bundle branch block (CLBBB) or received pacemaker implantations (PMIs) during the follow-up. At 6months after the procedure, 4 patients underwent PMIs for complete AV block (CAVB), and 4 patients had persistent CLBBB. Those that developed CLBBB and AVB had a higher morbidity from hypertension and lower estimated glomerular filtration rate (eGFR). The ECG, TTE, and CT parameters did not differ between the two groups. The ratio of the valve and LVOT area was significantly associated with a higher cumulative risk of events (HR, 3.005; 95% CI, 1.034-8.736; P<0.05).
  
  
  CONCLUSIONS
  Up to 20% of patients developed new CLBBB or CAVB and more than half were expected to recover. However, it required attention because approximately 40% were persistent. The ratio of the valve to LVOT area was an independent predictor.
authors.affiliation: Department of Cardiology, Keio University School of Medicine, Japan. Electronic address: ntakahiko914@gmail.com.
authors.forename: Takahiko
authors.initials: T
authors.lastname: Nishiyama
authors.affiliation: Department of Cardiology, Keio University School of Medicine, Japan.
authors.forename: Sho
authors.initials: S
authors.lastname: Tanosaki
authors.affiliation: Department of Cardiology, Keio University School of Medicine, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Tanaka
authors.affiliation: Department of Cardiology, Keio University School of Medicine, Japan.
authors.forename: Ryo
authors.initials: R
authors.lastname: Yanagisawa
authors.affiliation: Department of Cardiology, Keio University School of Medicine, Japan.
authors.forename: Fumiaki
authors.initials: F
authors.lastname: Yashima
authors.affiliation: Department of Cardiology, Keio University School of Medicine, Japan.
authors.forename: Takehiro
authors.initials: T
authors.lastname: Kimura
authors.affiliation: Department of Cardiology, Keio University School of Medicine, Japan.
authors.forename: Takahide
authors.initials: T
authors.lastname: Arai
authors.affiliation: Department of Cardiology, Keio University School of Medicine, Japan.
authors.forename: Hikaru
authors.initials: H
authors.lastname: Tsuruta
authors.affiliation: Department of Cardiology, Keio University School of Medicine, Japan.
authors.forename: Mitsushige
authors.initials: M
authors.lastname: Murata
authors.affiliation: Department of Cardiology, Keio University School of Medicine, Japan.
authors.forename: Yoshiyasu
authors.initials: Y
authors.lastname: Aizawa
authors.affiliation: Department of Cardiology, Keio University School of Medicine, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Kohno
authors.affiliation: Department of Cardiology, Keio University School of Medicine, Japan.
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Maekawa
authors.affiliation: Department of Cardiology, Keio University School of Medicine, Japan.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Hayashida
authors.affiliation: Department of Cardiology, Keio University School of Medicine, Japan.
authors.forename: Seiji
authors.initials: S
authors.lastname: Takatsuki
authors.affiliation: Department of Cardiology, Keio University School of Medicine, Japan.
authors.forename: Keiichi
authors.initials: K
authors.lastname: Fukuda
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002037:Bundle-Branch Block / Q000000981:diagnostic imaging* / Q000209:etiology* / Q000503:physiopathology; D004452:Echocardiography / Q000639:trends; D004562:Electrocardiography / Q000639:trends; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects* / Q000639:trends; D016896:Treatment Outcome
keywords: Aortic stenosis; Left bundle-branch block; Pacemaker; Transcatheter aortic valve implantation