Abstract
Background
Transcatheter aortic valve implantation (TAVI) has revolutionized the management of
severe aortic stenosis. The development of a new-onset complete left bundle branch
block (LBBB) is, however, a frequent complication. The objective of the present study
was to assess the impact of a new-onset LBBB after TAVI on the evolution of left ventricular
ejection fraction (LVEF).
Methods
Forty consecutive patients were included after the development of a new-onset LBBB
after TAVI and were matched for age and LVEF with 40 patients implanted during the
same period who did not develop an LBBB. The primary endpoint was evolution of the
LVEF measured by echocardiography before implantation and between 6 and 12 months
after TAVI.
Results
The development of an LBBB was associated with a 5-point decrease in LVEF [−12.5;
2.5], contrary to the non-LBBB group (1.5 [−6.5; 9.5], P = 0.007) at 8 months, with the persistence of the LBBB (n = 23) exacerbating this
decrease (−7 [−13; 2], P = 0.009). When left ventricular dysfunction (LVEF < 50%) was present before TAVI,
the appearance of an LBBB was associated with a reduction in LVEF (−2 [−8; 2]) contrary
to the non-LBBB group (20 [9; 22], P = 0.02).
Conclusions
The appearance of a new-onset LBBB after TAVI has a pejorative impact on left ventricular
systolic function, particularly in patients with an initial LVEF < 50%, due to a lack
of recovery of the latter, thereby potentially affecting their prognosis.
Résumé
Introduction
L’implantation valvulaire aortique par cathéter (TAVI) a révolutionné la prise en
charge de la sténose aortique grave. Toutefois, la survenue d’un nouveau bloc de branche
gauche (BBG) complet est une complication fréquente. L’objectif de la présente étude
était d’évaluer les conséquences de la survenue d’un nouveau BBG après le TAVI sur
l’évolution de la fraction d’éjection ventriculaire gauche (FEVG).
Méthodes
Nous avons sélectionné 40 patients consécutifs chez qui est survenu un nouveau BBG
après le TAVI et les avons appariés selon l’âge et la FEVG à 40 patients qui ont subi
une implantation durant la même période, mais qui n’ont pas eu de BBG. Le critère
de jugement principal était l’évolution de la FEVG mesurée par échocardiographie avant
l’implantation et de 6 à 12 mois après le TAVI.
Résultats
Contrairement au groupe sans BBG (1,5 [−6,5; 9,5], P = 0,007) après 8 mois, nous avons associé la survenue d’un BBG à une diminution de
la FEVG de 5 points [−12,5; 2,5], et à l’exacerbation de cette diminution en cas de
persistance du BBG (n = 23) (−7 [−13; 2], P = 0,009). De plus, contrairement au groupe sans BBG (20 [9; 22], P = 0,02), lorsque la dysfonction ventriculaire gauche (FEVG < 50 %) était présente
avant l'intervention TAVI, la survenue d’un BBG était associée à une réduction de
la FEVG (−2 [−8; 2]).
Conclusions
La survenue d’un nouveau BBG après le TAVI a des conséquences défavorables sur la
fonction systolique du ventricule gauche, notamment chez les patients qui ont une
FEVG initiale < 50 % à cause de l’absence de rétablissement de cette dernière, et
de ce fait nuit potentiellement à leur pronostic.
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Article info
Publication history
Published online: May 14, 2019
Accepted:
May 9,
2019
Received:
December 16,
2018
Footnotes
See editorial by Muntané-Carol et al., pages 1286–1288 of this issue.
See page 1392 for disclosure information.
Identification
Copyright
© 2019 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
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Access this article on ScienceDirectLinked Article
- New-Onset Left Bundle Branch Block Post-TAVI: No More an Innocent BystanderCanadian Journal of CardiologyVol. 35Issue 10
- PreviewTranscatheter aortic valve implantation (TAVI) has brought a new era in the treatment of aortic stenosis. During the last years, the successive iterations of transcatheter heart valve (THV) systems and the growing experience of centres/operators have translated into a progressive reduction in periprocedural complications. However, conduction disturbances, such as high-degree atrioventricular block and new-onset left bundle branch block (LBBB), have not decreased over time and remain the most frequent drawback of the procedure.
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