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See C, Wang Y, Huang H, Parise H, Yang Y, Tirziu D, Francese DP, Papoutsidakis N, Bader E, Kaple RK, Cleman M, Lansky AJ, Forrest JK. Impact of New-Onset Conduction Disturbances following Transcatheter Aortic Valve Replacement on Outcomes: A Single-Center Study. J Interv Cardiol 2023; 2023:5390338. [PMID: 37292113 PMCID: PMC10247319 DOI: 10.1155/2023/5390338] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 04/05/2023] [Accepted: 04/18/2023] [Indexed: 06/10/2023] Open
Abstract
Background Transcatheter aortic valve replacement (TAVR) is known to increase the incidence of conduction disturbances compared to surgical aortic valve replacement; however, there are limited data on the impact and duration of these conduction disturbances on longer term outcomes. Objective To determine the differential impact of persistent versus nonpersistent new-onset conduction disturbances on TAVR-related complications and outcomes. Methods This is a single-center retrospective analysis of 927 consecutive patients with aortic stenosis who underwent TAVR at Yale New Haven Hospital from July 2012 to August 2019. Patients with new-onset conduction disturbances within 7 days following TAVR were selected for this study. Persistent and nonpersistent disturbances were, respectively, defined as persisting or not persisting on all patient ECGs for up to 1.5 years after TAVR or until death. Results Within 7 days after TAVR, conduction disturbances occurred in 42.3% (392/927) of the patients. Conduction disturbances persisted in 150 (38%) patients and did not persist in 187 (48%) patients, and 55 (14%) patients were excluded for having mixed (both persistent and nonpersistent) disturbances. Compared with nonpersistent disturbances, patients with persistent disturbances were more likely to receive a PPM within 7 days after the TAVR procedure (46.0% versus 4.3%, p < 0.001) and had a greater unadjusted 1-year cardiac-related and all-cause mortality risk (HR 2.54, p=0.044 and HR 1.90, p=0.046, respectively). Conclusion Persistent conduction disturbances were associated with a greater cardiac and all-cause mortality rate at one year following TAVR. Future research should investigate periprocedural factors to reduce persistent conduction disturbances and outcomes beyond one year follow-up.
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Affiliation(s)
- Claudia See
- From the Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Yanting Wang
- From the Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA
- Hackensack Meridian Jersey Shore University Medical Center, NJ 07753, Neptune Township, USA
| | - Haocheng Huang
- Cardiovascular Medicine Clinical Research Analytics Group, Yale School of Medicine, New Haven, CT, USA
| | - Helen Parise
- From the Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA
- Cardiovascular Medicine Clinical Research Analytics Group, Yale School of Medicine, New Haven, CT, USA
| | - Yiping Yang
- From the Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Daniela Tirziu
- From the Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Dominic P. Francese
- From the Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Nikolaos Papoutsidakis
- From the Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Eric Bader
- From the Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Ryan K. Kaple
- From the Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA
- Hackensack Meridian Jersey Shore University Medical Center, NJ 07753, Neptune Township, USA
| | - Michael Cleman
- From the Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Alexandra J. Lansky
- From the Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA
- Barts Heart Centre, London and Queen Mary University of London, London, UK
| | - John K. Forrest
- From the Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA
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Occurrence and Persistency of Conduction Disturbances during Transcatheter Aortic Valve Implantation. ACTA ACUST UNITED AC 2021; 57:medicina57070695. [PMID: 34356976 PMCID: PMC8303948 DOI: 10.3390/medicina57070695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 07/02/2021] [Accepted: 07/06/2021] [Indexed: 11/17/2022]
Abstract
Background and Objectives: Conduction disturbances such as left bundle branch block (LBBB) and complete atrio-ventricular block (cAVB) are relatively frequent complications following trans-catheter aortic valve implantation (TAVI). We investigated the dynamics of these conduction blocks to further understand luxating factors and predictors for their persistency. Materials and Methods: We prospectively included 157 consecutive patients who underwent a TAVI procedure. Electrocardiograms (ECGs) were obtained at specific time points during the TAVI procedure and at follow-up until at least six months post-procedure. Results: Of the 106 patients with a narrow QRS complex (nQRS) before TAVI, ~70% developed LBBB; 28 (26.4%) being classified as super-transient (ST-LBBB), 20 (18.9%) as transient (T-LBBB) and 24 (22.6%) as persistent (P-LBBB). Risk of LBBB was higher for self-expandable (SE) than for balloon-expandable (BE) prostheses and increased with larger implant depth. During the TAVI procedure conduction disturbances showed a dynamic behavior, as illustrated by alternating kinds of blocks in 18 cases. Most LBBBs developed during balloon aortic valvuloplasty (BAV) and at positioning and deployment of the TAVI prosthesis. The incidence of LBBB was not significantly different between patients who did and did not undergo BAV prior to TAVI implantation (65.3% and 74.2%, respectively (p = 0.494)). Progression to cAVB was most frequent for patients with preexisting conduction abnormalities (5/34) patients) and in patients showing ST-LBBB (6/28). Conclusions: During the TAVI procedure, conduction disturbances showed a dynamic behavior with alternating types of block in 18 cases. After a dynamic period of often alternating types of block, most BBBs are reversible while one third persist. Patients with ST-LBBB are most prone to progressing into cAVB. The observation that the incidence of developing LBBB after TAVI is similar with and without BAV suggests that a subgroup of patients has a substrate to develop LBBB regardless of the procedure.
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Poels TT, Stassen R, Kats S, Veenstra L, van Ommen V, Kietselaer B, Houthuizen P, Maessen JG, Prinzen FW. Effective Distance between Aortic Valve and Conduction System Is an Independent Predictor of Persistent Left Bundle Branch Block during Transcatheter Aortic Valve Implantation. ACTA ACUST UNITED AC 2021; 57:medicina57050476. [PMID: 34064932 PMCID: PMC8150689 DOI: 10.3390/medicina57050476] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 05/04/2021] [Accepted: 05/05/2021] [Indexed: 01/05/2023]
Abstract
Background and objectives: Persistent left bundle branch block (P-LBBB) has been associated with poor clinical outcomes of transcatheter aortic valve implantation (TAVI) procedures. We hypothesized that the distance from the aortic valve to the proximal conduction system, expressed as the effective distance between the aortic valve and conduction system (EDACS), can predict the occurrence of P-LBBB in patients undergoing a TAVI procedure. Materials and methods: In a retrospective study, data from 269 patients were analyzed. EDACS was determined using two longitudinal CT sections. Results: Sixty-four of the patients developed P-LBBB. EDACS ranged between −3 and +18 mm. EDACS was significantly smaller in P-LBBB than in non-P-LBBB patients (4.6 (2.2–7.1) vs. 8.0 (5.8–10.2) mm, median values (interquartile range); p < 0.05). Receiver operating characteristic analysis showed an area under the curve of 0.78 for predicting P-LBBB based on EDACS. In patients with EDACS of ≤3 mm and >10 mm, the chance of developing P-LBBB was ≥50% and <10%, respectively. Conclusions: A small EDACS increases the risk for the development of P-LBBB during TAVI by a factor of >25. As EDACS can be measured pre-procedurally, it may be a valuable additional factor to weigh the risks of transcatheter and surgical aortic valve replacement.
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Affiliation(s)
- Thomas T. Poels
- Department of Cardiothoracic Surgery, Maastricht University Medical Center, P.O. Box 5800, 6229HX Maastricht, The Netherlands; (R.S.); (S.K.); (J.G.M.)
- Correspondence:
| | - Robert Stassen
- Department of Cardiothoracic Surgery, Maastricht University Medical Center, P.O. Box 5800, 6229HX Maastricht, The Netherlands; (R.S.); (S.K.); (J.G.M.)
| | - Suzanne Kats
- Department of Cardiothoracic Surgery, Maastricht University Medical Center, P.O. Box 5800, 6229HX Maastricht, The Netherlands; (R.S.); (S.K.); (J.G.M.)
| | - Leo Veenstra
- Department of Cardiology, Maastricht University Medical Center, P.O. Box 5800, 6229HX Maastricht, The Netherlands; (L.V.); (V.v.O.); (B.K.)
| | - Vincent van Ommen
- Department of Cardiology, Maastricht University Medical Center, P.O. Box 5800, 6229HX Maastricht, The Netherlands; (L.V.); (V.v.O.); (B.K.)
| | - Bastiaan Kietselaer
- Department of Cardiology, Maastricht University Medical Center, P.O. Box 5800, 6229HX Maastricht, The Netherlands; (L.V.); (V.v.O.); (B.K.)
| | - Patrick Houthuizen
- Department of Cardiology, Catharina Hospital Eindhoven, P.O. Box 1350, 5623EJ Eindhoven, The Netherlands;
| | - Jos G. Maessen
- Department of Cardiothoracic Surgery, Maastricht University Medical Center, P.O. Box 5800, 6229HX Maastricht, The Netherlands; (R.S.); (S.K.); (J.G.M.)
| | - Frits W. Prinzen
- CARIM School for Cardiovascular Diseases, P.O. Box 616, 6229ER Maastricht, The Netherlands;
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Pérez-Riera AR, Barbosa-Barros R, Daminello-Raimundo R, de Abreu LC, Nikus K. The Vectorcardiogram and the Main Dromotropic Disturbances. Curr Cardiol Rev 2021; 17:50-59. [PMID: 32778036 PMCID: PMC8142362 DOI: 10.2174/1573403x16666200810105504] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 04/27/2020] [Accepted: 04/27/2020] [Indexed: 02/01/2023] Open
Abstract
Until the mid-1980s, it was believed that the vectorcardiogram (VCG) presented a greater specificity, sensitivity and accuracy in comparison to the 12-lead electrocardiogram (ECG), in the cardiology diagnosis. Currently, the VCG still is superior to the ECG in specific situations, such as in the evaluation of myocardial infarctions when associated with intraventricular conduction disturbances, in the identification and location of accessory pathways in ventricular preexcitation, in the differential diagnosis of patterns varying from normal of electrical axis deviation, in the evaluation of particular aspects of Brugada syndrome, Brugada phenocopies, concealed form of arrhythmogenic right ventricular cardiomyopathy and zonal or fascicular blocks of the right bundle branch on right ventricular free wall.VCG allows us to analyze the presence of left septal fascicular block more accurately than ECG and in the diagnosis of the interatrial blocks and severity of some chambers enlargements. The three-dimensional spatial orientation of both the atrial and the ventricular activity provides a far more complete observation tool than the linear ECG. We believe that the ECG/VCG binomial simultaneously obtained by the technique called electro-vectorcardiography (ECG/VCG) brought a significant gain for the differential diagnosis of several pathologies. Finally, in the field of education and research, VCG provided a better and more rational tridimensional insight into the electrical phenomena that occurs spatially, and represented an important impact on the progress of electrocardiography.
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Affiliation(s)
- Andrés R Pérez-Riera
- Laboratorio de Delineamento de Estudos e Escrita Científica, Centro Universitario Saude ABC, Santo Andre, Sao Paulo, Brazil
| | - Raimundo Barbosa-Barros
- Coronary Center of the Hospital de Messejana Dr. Carlos Alberto Studart Gomes, Fortaleza, Ceara, Brazil
| | - Rodrigo Daminello-Raimundo
- Laboratorio de Delineamento de Estudos e Escrita Científica, Centro Universitario Saude ABC, Santo Andre, Sao Paulo, Brazil
| | - Luiz C de Abreu
- Laboratorio de Delineamento de Estudos e Escrita Científica, Centro Universitario Saude ABC, Santo Andre, Sao Paulo, Brazil
| | - Kjell Nikus
- Heart Center, Tampere University Hospital and Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
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Nazif TM, Chen S, George I, Dizon JM, Hahn RT, Crowley A, Alu MC, Babaliaros V, Thourani VH, Herrmann HC, Smalling RW, Brown DL, Mack MJ, Kapadia S, Makkar R, Webb JG, Leon MB, Kodali SK. New-onset left bundle branch block after transcatheter aortic valve replacement is associated with adverse long-term clinical outcomes in intermediate-risk patients: an analysis from the PARTNER II trial. Eur Heart J 2019; 40:2218-2227. [DOI: 10.1093/eurheartj/ehz227] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 11/02/2018] [Accepted: 04/01/2019] [Indexed: 11/14/2022] Open
Abstract
Abstract
Aims
Transcatheter aortic valve replacement (TAVR) is now an established therapy for intermediate-risk surgical candidates with symptomatic, severe aortic stenosis. The clinical impact of new-onset left bundle branch block (LBBB) after TAVR remains controversial and has not been studied in intermediate-risk patients. We therefore sought to analyse outcomes associated with new LBBB in a large cohort of intermediate-risk patients treated with TAVR.
Methods and results
A total of 2043 patients underwent TAVR in the PARTNER II trial and S3 intermediate-risk registry and survived to hospital discharge. Patients were excluded from the current analysis due to baseline conduction disturbances, pre-existing permanent pacemaker (PPM), and new PPM during the index hospitalization. Clinical outcomes at 2 years were compared between patients with and without persistent, new-onset LBBB at hospital discharge, and multivariable analysis was performed to identify predictors of mortality. Among 1179 intermediate-risk patients, new-onset LBBB at discharge occurred in 179 patients (15.2%). Patients with new LBBB were similar to those without except for more frequent diabetes and more frequent treatment with SAPIEN 3 vs. SAPIEN XT. At 2 years, new LBBB was associated with increased rates of all-cause mortality (19.3% vs. 10.8%, P = 0.002), cardiovascular mortality (16.2% vs. 6.5%, P < 0.001), rehospitalization, and new PPM implantation. By multivariable analysis, new LBBB remained an independent predictor of 2-year all-cause [hazard ratio (HR) 1.98, 95% confidence interval (95% CI) 1.33, 2.96; P < 0.001] and cardiovascular (HR 2.66 95% CI 1.67, 4.24; P < 0.001) mortality. New LBBB was also associated with worse left ventricular systolic function at 1 and 2-year follow-up.
Conclusions
In a large cohort of intermediate-risk patients from the PARTNER II trial and registry, persistent, new-onset LBBB occurred in 15.2% of patients without baseline conduction disturbances or pacemaker. New LBBB was associated with adverse clinical outcomes at 2 years, including all-cause and cardiovascular mortality, rehospitalization, new pacemaker implantation, and worsened left ventricular systolic function.
Clinical Trial Registration
ClinicalTrials.gov #NCT01314313 and NCT03222128.
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Affiliation(s)
- Tamim M Nazif
- Columbia University Irving Medical Center/New York-Presbyterian Hospital, 177 Fort Washington Avenue, 5th Floor, Room 5C-501, New York, NY, USA
| | - Shmuel Chen
- Cardiovascular Research Foundation, New York, NY, USA
| | - Isaac George
- Columbia University Irving Medical Center/New York-Presbyterian Hospital, 177 Fort Washington Avenue, 5th Floor, Room 5C-501, New York, NY, USA
| | - Jose M Dizon
- Columbia University Irving Medical Center/New York-Presbyterian Hospital, 177 Fort Washington Avenue, 5th Floor, Room 5C-501, New York, NY, USA
| | - Rebecca T Hahn
- Columbia University Irving Medical Center/New York-Presbyterian Hospital, 177 Fort Washington Avenue, 5th Floor, Room 5C-501, New York, NY, USA
| | - Aaron Crowley
- Cardiovascular Research Foundation, New York, NY, USA
| | - Maria C Alu
- Columbia University Irving Medical Center/New York-Presbyterian Hospital, 177 Fort Washington Avenue, 5th Floor, Room 5C-501, New York, NY, USA
| | | | - Vinod H Thourani
- Medstar Heart & Vascular Institute/Washington Hospital Center, Washington, DC, USA
| | - Howard C Herrmann
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Richard W Smalling
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | | | | | | | - Raj Makkar
- Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - John G Webb
- St. Paul’s Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Martin B Leon
- Columbia University Irving Medical Center/New York-Presbyterian Hospital, 177 Fort Washington Avenue, 5th Floor, Room 5C-501, New York, NY, USA
| | - Susheel K Kodali
- Columbia University Irving Medical Center/New York-Presbyterian Hospital, 177 Fort Washington Avenue, 5th Floor, Room 5C-501, New York, NY, USA
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Pérez-Riera AR, Barbosa-Barros R, de Rezende Barbosa MPC, Daminello-Raimundo R, de Abreu LC, Nikus K. Left bundle branch block: Epidemiology, etiology, anatomic features, electrovectorcardiography, and classification proposal. Ann Noninvasive Electrocardiol 2018; 24:e12572. [PMID: 29932265 DOI: 10.1111/anec.12572] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 04/28/2018] [Accepted: 05/14/2018] [Indexed: 01/25/2023] Open
Abstract
In left bundle branch block (LBBB), the ventricles are activated in a sequential manner with alterations in left ventricular mechanics, perfusion, and workload resulting in cardiac remodeling. Underlying molecular, cellular, and interstitial changes manifest clinically as changes in size, mass, geometry, and function of the heart. Cardiac remodeling is associated with progressive ventricular dysfunction, arrhythmias, and impaired prognosis. Clinical and diagnostic notions about LBBB have evolved from a simple electrocardiographic alteration to a critically important finding affecting diagnostic and clinical management of many patients. Advances in cardiac magnetic resonance imaging have significantly improved the assessment of patients with LBBB and provided additional insights into pathophysiological mechanisms of left ventricular remodeling. In this review, we will discuss the epidemiology, etiologies, and electrovectorcardiographic features of LBBB and propose a classification of the conduction disturbance.
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Affiliation(s)
- Andrés R Pérez-Riera
- Design of Studies and Scientific Writing Laboratory, ABC School of Medicine, São Paulo, Brazil
| | - Raimundo Barbosa-Barros
- Coronary Center, Messejana Hospital Dr. Carlos Alberto Studart Gomes, Fortaleza, Ceará, Brazil
| | | | | | - Luiz C de Abreu
- Design of Studies and Scientific Writing Laboratory, ABC School of Medicine, São Paulo, Brazil
| | - Kjell Nikus
- Heart Center, Tampere University Hospital and Faculty of Medicine and Life Sciences, University of Tampere, Finland
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Becker M, Blangy H, Folliguet T, Villemin T, Freysz L, Luc A, Maureira P, Popovic B, Olivier A, Sadoul N. Incidence, indications and predicting factors of permanent pacemaker implantation after transcatheter aortic valve implantation: A retrospective study. Arch Cardiovasc Dis 2017. [PMID: 28647466 DOI: 10.1016/j.acvd.2017.03.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND As the number of transcatheter aortic valve implantation (TAVI) procedures is constantly increasing, it is important to consider common complications, such as pacemaker (PM) implantation, and their specific risk factors. AIMS Echocardiographic, computed tomography and electrocardiographic data were analysed to determine the predicting factors, if any, associated with PM implantation. METHODS This retrospective study included patients referred to Nancy University Hospital for a TAVI procedure from January 2013 to December 2015. Both Medtronic CoreValve and Edwards SAPIEN valves were implanted. Patients with preprocedurally implanted PMs and/or referred from another institution were excluded. RESULTS Of 208 TAVI patients, 23 had a pre-existing PM and were excluded. A new PM was required in 38 patients (20.5%). Pre-existing right bundle branch block (RBBB), the use of the Medtronic CoreValve and large prostheses were identified as predictors of PM implantation (P=0.0361, P=0.0004 and P=0.0019, respectively). Using logistic regression, predictors of PM implantation included first-degree atrioventricular block (odds ratio 3.7, 95% confidence interval 1.5-9.1; P=0.0054) and large aortic annulus diameter in echocardiography (odds ratio 1.2, 95% confidence interval 1-1.4; P=0.0447), with a threshold of 24.1mm. For the combination of preTAVI PR duration >220ms and QRS duration >120ms, the positive predictive value for PM implantation reached 80%. CONCLUSION Use of the Medtronic CoreValve, RBBB and first-degree atrioventricular block are major risk factors for post-TAVI PM implantation. In addition, large aortic annulus and large valvular prosthesis are independent risk factors for PM implantation. The combination of preTAVI prolonged PR interval and increased QRS duration could be used as a marker for periprocedural PM implantation.
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Affiliation(s)
- Mathieu Becker
- Département de cardiologie, CHU de Nancy, 54511 Vandœuvre-lès-Nancy, France
| | - Hugues Blangy
- Département de cardiologie, CHU de Nancy, 54511 Vandœuvre-lès-Nancy, France
| | - Thierry Folliguet
- Département de cardiologie, CHU de Nancy, 54511 Vandœuvre-lès-Nancy, France; Université de Lorraine, 54000 Nancy, France
| | - Thibault Villemin
- Département de cardiologie, CHU de Nancy, 54511 Vandœuvre-lès-Nancy, France; Université de Lorraine, 54000 Nancy, France
| | - Luc Freysz
- Département de cardiologie, CHU de Nancy, 54511 Vandœuvre-lès-Nancy, France
| | - Amandine Luc
- ESPRI-Biobase unit, PARC, university hospital of Nancy, 54511 Vandœuvre-lès-Nancy, France
| | - Pablo Maureira
- Département de cardiologie, CHU de Nancy, 54511 Vandœuvre-lès-Nancy, France; Université de Lorraine, 54000 Nancy, France
| | - Batric Popovic
- Département de cardiologie, CHU de Nancy, 54511 Vandœuvre-lès-Nancy, France
| | - Arnaud Olivier
- Département de cardiologie, CHU de Nancy, 54511 Vandœuvre-lès-Nancy, France; Université de Lorraine, 54000 Nancy, France
| | - Nicolas Sadoul
- Département de cardiologie, CHU de Nancy, 54511 Vandœuvre-lès-Nancy, France; Université de Lorraine, 54000 Nancy, France.
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Surkova E, Badano LP, Bellu R, Aruta P, Sambugaro F, Romeo G, Migliore F, Muraru D. Left bundle branch block: from cardiac mechanics to clinical and diagnostic challenges. Europace 2017; 19:1251-1271. [DOI: 10.1093/europace/eux061] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 02/14/2017] [Indexed: 12/15/2022] Open
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Dobson LE, Musa TA, Uddin A, Fairbairn TA, Bebb OJ, Swoboda PP, Haaf P, Foley J, Garg P, Fent GJ, Malkin CJ, Blackman DJ, Plein S, Greenwood JP. The impact of trans-catheter aortic valve replacement induced left-bundle branch block on cardiac reverse remodeling. J Cardiovasc Magn Reson 2017; 19:22. [PMID: 28222749 PMCID: PMC5320804 DOI: 10.1186/s12968-017-0335-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 02/02/2017] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Left bundle branch block (LBBB) is common following trans-catheter aortic valve replacement (TAVR) and has been linked to increased mortality, although whether this is related to less favourable cardiac reverse remodeling is unclear. The aim of the study was to investigate the impact of TAVR induced LBBB on cardiac reverse remodeling. METHODS 48 patients undergoing TAVR for severe aortic stenosis were evaluated. 24 patients with new LBBB (LBBB-T) following TAVR were matched with 24 patients with a narrow post-procedure QRS (nQRS). Patients underwent cardiovascular magnetic resonance (CMR) prior to and 6 m post-TAVR. Measured cardiac reverse remodeling parameters included left ventricular (LV) size, ejection fraction (LVEF) and global longitudinal strain (GLS). Inter- and intra-ventricular dyssynchrony were determined using time to peak radial strain derived from CMR Feature Tracking. RESULTS In the LBBB-T group there was an increase in QRS duration from 96 ± 14 to 151 ± 12 ms (P < 0.001) leading to inter- and intra-ventricular dyssynchrony (inter: LBBB-T 130 ± 73 vs nQRS 23 ± 86 ms, p < 0.001; intra: LBBB-T 118 ± 103 vs. nQRS 13 ± 106 ms, p = 0.001). Change in indexed LV end-systolic volume (LVESVi), LVEF and GLS was significantly different between the two groups (LVESVi: nQRS -7.9 ± 14.0 vs. LBBB-T -0.6 ± 10.2 ml/m2, p = 0.02, LVEF: nQRS +4.6 ± 7.8 vs LBBB-T -2.1 ± 6.9%, p = 0.002; GLS: nQRS -2.1 ± 3.6 vs. LBBB-T +0.2 ± 3.2%, p = 0.024). There was a significant correlation between change in QRS and change in LVEF (r = -0.434, p = 0.002) and between change in QRS and change in GLS (r = 0.462, p = 0.001). Post-procedure QRS duration was an independent predictor of change in LVEF and GLS at 6 months. CONCLUSION TAVR-induced LBBB is associated with less favourable cardiac reverse remodeling at medium term follow up. In view of this, every effort should be made to prevent TAVR-induced LBBB, especially as TAVR is now being extended to a younger, lower risk population.
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Affiliation(s)
- Laura E. Dobson
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
| | - Tarique A. Musa
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
| | - Akhlaque Uddin
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
| | - Timothy A. Fairbairn
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
| | - Owen J. Bebb
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
| | - Peter P. Swoboda
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
| | - Philip Haaf
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
| | - James Foley
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
| | - Pankaj Garg
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
| | - Graham J. Fent
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
| | | | - Daniel J. Blackman
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, LS1 3EX UK
| | - Sven Plein
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, LS1 3EX UK
| | - John P. Greenwood
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, LS1 3EX UK
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Conduction disturbances after transcatheter aortic valve implantation procedures - predictors and management. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2016; 12:203-11. [PMID: 27625682 PMCID: PMC5011535 DOI: 10.5114/aic.2016.61640] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 06/29/2016] [Indexed: 12/02/2022] Open
Abstract
Transcatheter aortic valve implantation (TAVI) has become a safe and efficient alternative to cardiac surgery in patients with severe aortic stenosis. In many countries the number of performed TAVI procedures equals the number of surgical implantations. Indications for TAVI are becoming more liberal, allowing a wider spectrum of patients to benefit from the advantages of transcatheter therapy. Due to its invasive nature, TAVI is associated with some complications such as conduction disturbances. Although these disturbances are usually not lethal, they have a great influence on patients’ state and long term-survival. The most relevant and common are His’ bundle branch blocks, atrioventricular blocks, and need for permanent pacemaker implantation. With the frequency at 10% to even 50%, conduction abnormalities are among the most important TAVI-related adverse events. Risk factors for conduction disturbances include age, anatomy of the heart, periprocedural factors, type of implanted valve, and comorbidities. Severity of occurring complications varies; therefore selection of a proper treatment approach is required. Considered as the most effective management, permanent pacemaker implantation turned out to negatively influence both recovery and survival. Moreover, there is no expert consensus on use of resynchronization therapy after TAVI. In this paper, the authors present a comprehensive analysis of the most common conduction disturbances accompanying TAVI, factors related to their occurrence, and treatment approach.
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11
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Bazoukis G, Tsimos K, Korantzopoulos P. Episodic Left Bundle Branch Block-A Comprehensive Review of the Literature. Ann Noninvasive Electrocardiol 2016; 21:117-25. [PMID: 27296905 DOI: 10.1111/anec.12361] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 01/10/2016] [Accepted: 01/19/2016] [Indexed: 01/09/2023] Open
Abstract
Episodic (transient/ intermittent) left bundle branch block (LBBB) has been associated with different conditions such as bradycardia, tachycardia, anesthesia, acute pulmonary embolism, changes in intrathoracic pressure, chest trauma, cardiac interventional procedures, mad honey poisoning, and in other clinical settings. Of note, exclusion of an acute coronary syndrome in the setting of episodic LBBB is of great importance. Moreover, episodic LBBB is sometimes symptomatic and may be associated with left ventricular systolic and/or diastolic dysfunction or conduction disturbances leading to syncope. This review article provides a comprehensive overview of the conditions associated with episodic LBBB and discusses the clinical impact of this phenomenon.
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Affiliation(s)
- George Bazoukis
- Department of Internal Medicine, General Hospital of Athens "Elpis,", Athens, Greece
| | - Konstantinos Tsimos
- First Department of Cardiology, University of Ioannina, Medical School, Ioannina, Greece
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Influence of QRS infarct score and QRS duration prior to transcatheter aortic valve replacement on follow-up left ventricular end systolic volume in patients with new persistent left bundle branch block. J Electrocardiol 2015; 48:637-42. [PMID: 25959263 DOI: 10.1016/j.jelectrocard.2015.04.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND New-onset left bundle branch block (LBBB) is a known complication during Transcatheter Aortic Valve Replacement (TAVR). This study evaluated the influence of pre-TAVR cardiac conditions on left ventricular functions in patients with new persistent LBBB post-TAVR. METHODS Only 11 patients qualified for this study because of the strict inclusion criteria. Pre-TAVR electrocardiograms were evaluated for Selvester QRS infarct score and QRS duration, and left ventricular end-systolic volume (LVESV) was used as outcome variable. RESULTS There was a trend towards a positive correlation between QRS score and LVESV of r=0.59 (p=0.058), while there was no relationship between QRS duration and LVESV (r=-0.18 [p=0.59]). CONCLUSION This study showed that patients with new LBBB and higher pre-TAVR QRS infarct score may have worse post-TAVR left ventricular function, however, pre-TAVR QRS duration has no such predictive value. Because of the small sample size these results should be interpreted with caution and assessed in a larger study population.
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