Predictive factor and clinical consequence of left bundle-branch block after a transcatheter aortic valve implantation

Takahiko Nishiyama, Sho Tanosaki, Makoto Tanaka, Ryo Yanagisawa, Fumiaki Yashima, Takehiro Kimura, Takahide Arai, Hikaru Tsuruta, Mitsushige Murata, Yoshiyasu Aizawa, Takashi Kohno, Yuichiro Maekawa, Kentaro Hayashida, Seiji Takatsuki, Keiichi Fukuda

Research output: Contribution to journalArticle

10 Citations (Scopus)

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 6 months 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 6 months 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.

Original languageEnglish
Pages (from-to)25-29
Number of pages5
JournalInternational Journal of Cardiology
Volume227
DOIs
Publication statusPublished - 2017 Jan 15

Fingerprint

Bundle-Branch Block
Aortic Valve
Atrioventricular Block
Echocardiography
Electrocardiography
Glomerular Filtration Rate
Transcatheter Aortic Valve Replacement
Hypertension
Morbidity
Incidence

Keywords

  • Aortic stenosis
  • Left bundle-branch block
  • Pacemaker
  • Transcatheter aortic valve implantation

ASJC Scopus subject areas

  • Medicine(all)
  • Cardiology and Cardiovascular Medicine

Cite this

Predictive factor and clinical consequence of left bundle-branch block after a transcatheter aortic valve implantation. / Nishiyama, Takahiko; Tanosaki, Sho; Tanaka, Makoto; Yanagisawa, Ryo; Yashima, Fumiaki; Kimura, Takehiro; Arai, Takahide; Tsuruta, Hikaru; Murata, Mitsushige; Aizawa, Yoshiyasu; Kohno, Takashi; Maekawa, Yuichiro; Hayashida, Kentaro; Takatsuki, Seiji; Fukuda, Keiichi.

In: International Journal of Cardiology, Vol. 227, 15.01.2017, p. 25-29.

Research output: Contribution to journalArticle

Nishiyama, T, Tanosaki, S, Tanaka, M, Yanagisawa, R, Yashima, F, Kimura, T, Arai, T, Tsuruta, H, Murata, M, Aizawa, Y, Kohno, T, Maekawa, Y, Hayashida, K, Takatsuki, S & Fukuda, K 2017, 'Predictive factor and clinical consequence of left bundle-branch block after a transcatheter aortic valve implantation', International Journal of Cardiology, vol. 227, pp. 25-29. https://doi.org/10.1016/j.ijcard.2016.11.063
Nishiyama, Takahiko ; Tanosaki, Sho ; Tanaka, Makoto ; Yanagisawa, Ryo ; Yashima, Fumiaki ; Kimura, Takehiro ; Arai, Takahide ; Tsuruta, Hikaru ; Murata, Mitsushige ; Aizawa, Yoshiyasu ; Kohno, Takashi ; Maekawa, Yuichiro ; Hayashida, Kentaro ; Takatsuki, Seiji ; Fukuda, Keiichi. / Predictive factor and clinical consequence of left bundle-branch block after a transcatheter aortic valve implantation. In: International Journal of Cardiology. 2017 ; Vol. 227. pp. 25-29.
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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 6 months 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 6 months 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.",
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T1 - Predictive factor and clinical consequence of left bundle-branch block after a transcatheter aortic valve implantation

AU - Nishiyama, Takahiko

AU - Tanosaki, Sho

AU - Tanaka, Makoto

AU - Yanagisawa, Ryo

AU - Yashima, Fumiaki

AU - Kimura, Takehiro

AU - Arai, Takahide

AU - Tsuruta, Hikaru

AU - Murata, Mitsushige

AU - Aizawa, Yoshiyasu

AU - Kohno, Takashi

AU - Maekawa, Yuichiro

AU - Hayashida, Kentaro

AU - Takatsuki, Seiji

AU - Fukuda, Keiichi

PY - 2017/1/15

Y1 - 2017/1/15

N2 - 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 6 months 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 6 months 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.

AB - 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 6 months 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 6 months 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.

KW - Aortic stenosis

KW - Left bundle-branch block

KW - Pacemaker

KW - Transcatheter aortic valve implantation

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