Incidence and management of atrioventricular conduction disorders in new-onset left bundle branch block after TAVI: A prospective multicenter study

BACKGROUND New-onset left bundle branch block (LBBB) is one of the most frequent complications after transcatheter aortic valve implantation (TAVI) and is associated with delayed high degree atrioventricular (AV) block.OBJECTIVES The objectives of this study were to determine the incidence of AV block in such a population and to assess the perfor-mance and safety of a risk stratification algorithm on the basis of electrophysiology study (EPS) followed by implantation of a pace-maker or implantable loop recorder (ILR).METHODS This was a prospective open-label study with 12-month follow-up. From June 8, 2015, to November 8, 2018, 183 TAVI recip-ients (mean age 82.3 6 5.9 years) were included at 10 centers. New-onset LBBB after TAVI persisting for .24 hours was assessed by electrophysiology study during initial hospitalization. High-risk patients (His-ventricle interval >70 ms) were implanted with a dual-chamber pacemaker recording AV conduction disturbance ep-isodes. Patients at lower risk were implanted with an ILR with auto-matic remote monitoring.RESULTS A high-grade AV conduction disorder was identified in 56 patients (30.6%) at 12 months. Four subjects were symptomatic, all in the ILR group. No complications were associated with the strat-ification procedure. Patients with His-ventricle interval >70 ms dis-played more high-grade AV conduction disorders (53.2% [25 of 47] vs 22.8% [31 of 136]; P , .001). In a multivariate analysis, His-ventricle interval >70 ms was independently associated with the occurrence of a high-grade conduction disorder (subdistribution hazard ratio 2.4; 95% confidence interval 1.2-4.8; P 5 .010).CONCLUSION New-onset LBBB after TAVI was associated with high rates of high-grade AV conduction disturbances. The stratification algorithm provided safe and valuable aid to management decisions and reliable guidance on pacemaker implantation.

Automated summary

This study aimed to determine the incidence of high-degree atrioventricular block (AVB) after transcatheter aortic valve implantation (TAVI), and evaluate the performance and safety of a risk stratification algorithm based on electrophysiology study (EPS) followed by implantation of a pacemaker or implantable loop recorder (ILR). The study found that new-onset left bundle branch block (LBBB) after TAVI was associated with high rates of high-grade AV conduction disturbances, and the stratification algorithm provided safe and valuable aid to management decisions and reliable guidance on pacemaker implantation.