Maladies cardiovasculaires et diagnostic

Reversibility of New Onset LBBB between Balloon-Expandable Valves and Self-Expandable Valves

Abstract

Owais T, El-Garhy M, Abdulrahman M, Hansig M, Lauten P, Lapp H, Kuntze T and Sigusch H

Objective: LBBB is not a rare complication after TAVI. Available data on the reversibility of new-onset left bundle branch block (LBBB) after transcatheter aortic valve replacement (TAVR) in relation to valve type and other factors remain controversial. We aimed to find out factors that might be responsible for the reversibility of this complication post implantation.

Method: In this retrospective observational study, we reviewed all TAVI patients operated in our institute from July 2014 to July 2019. We included patients who developed new LBBB post TAVI and excluded patients with preexisting pacemaker, preoperative LBBB and patients requiring Permanent pacemaker post-operatively during the index hospitalization. Twelve-lead electrocardiograms at baseline, immediately after TAVI and at 30-days follow-up were evaluated. Disappearance of the LBBB in follow-up was analyzed to find out patient and procedural characteristics. Out of 1247 patients operated in this 5 years period, 299 (24%) patients developed new onset LBBB. 77 patients (26%) and 179 patients (59.8%) of these patients had complete resolution before discharge and at the 30-day follow-up respectively. 40.1% showed persistent LBBB after 30 days without the need for pacemaker due to atrioventricular block during the follow up. Only one patient received a CRT pacemaker due to persistent LBBB and severely reduced ejection fraction.

Results: Reversibility of LBBB was documented in 14.3% of patients who received Sapien balloon expandable valve, in 0% of patients with Core valves and in 66.7% patients with of Symetis valve. No patients had additional conduction abnormalities at 30-day follow-up. The patients with irreversible LBBB had a lower ejection fraction (37.5% ± 7.8 vs. 69% ± 4.7, p-value 0.04), and higher proBNP (2728 ± 112 vs. 495 ± 122, p-value 0.03). Septal hypertrophy was more prominent in patients with irreversible LBBB (14 ± 2.6 vs. 13 ± 1.4, p-value 0.004). Annulus diameter was significantly larger in patients with irreversible LBBB (25 ± 1.5 mm vs. 22.5 ± 0.5 mm, p-value 0.001). Preimplantation valvoplasty OR (95% CI): 1.3 (1.1-1.9); p-value 0.04, Sapien valve: 2 (1.1-4); p-value 0.036 were predictive for persistence of LBBB. However, Symetis valve or (95% CI): 0.5 (0.2-0.8); p-value 0.02 and LAHB 0.3 (0.1-0.6); p-value 0.001 were independent predictors of reversible LBBB.

Conclusion: New onset LBBB after self-expandable valves has a reversible nature and resolve probably by 30 day follow-up with a relevant tendency to stabilization especially in patients without balloon predilataion and in patients who received Symetis valve.