Comparison of incidence and predictors of left bundle branch block after transcatheter aortic valve implantation using the corevalve versus the edwards valve

Irene Franzoni, Azeem Latib, Francesco Maisano, Charis Costopoulos, Luca Testa, Filippo Figini, Francesco Giannini, Sandeep Basavarajaiah, Marco Mussardo, Massimo Slavich, Maurizio Taramasso, Micaela Cioni, Matteo Longoni, Santo Ferrarello, Andrea Radinovic, Simone Sala, Silvia Ajello, Alessandro Sticchi, Manuela Giglio, Eustachio AgricolaAlaide Chieffo, Matteo Montorfano, Ottavio Alfieri, Antonio Colombo

Research output: Contribution to journalArticlepeer-review

88 Scopus citations

Abstract

Conduction disorders and permanent pacemaker implantation are common complications in patients who undergo transcatheter aortic valve implantation (TAVI). The aim of this study was to assess the incidence and clinical significance of new bundle branch block in patients who underwent TAVI with the Medtronic CoreValve Revalving System (MCRS) or the Edwards SAPIEN valve (ESV). Data from 238 patients with no previous pacemaker implantation, left bundle branch block (LBBB) or right bundle branch block at baseline electrocardiography who underwent TAVI with either MCRS (n = 87) or ESV (n = 151) bioprostheses from 2007 to 2011 were analyzed. New-onset LBBB occurred in 26.5% patients (n = 63): 13.5% with the ESV (n = 20) and 50.0% with the MCRS (n = 43) (p = 0.001). Permanent pacemaker implantation was required in 12.7% of patients (n = 8) because of complete atrioventricular block (ESV n = 2, MCRS n = 4), LBBB and first degree atrioventricular block (MCRS n = 1) and new-onset LBBB associated with sinus bradycardia (MCRS n = 1). At discharge, LBBB persisted in 8.6% of ESV patients (n = 13) and 32.2% of MCRS patients (n = 28) (p = 0.001). On multivariate analysis, the only predictor of LBBB was MCRS use (odds ratio 7.2, 95% confidence interval 2.9 to 17.4, p <0.001). Persistent new-onset LBBB at discharge was not associated with overall (log-rank p = 0.42) or cardiovascular (log-rank p = 0.46) mortality. New-onset right bundle branch block was documented in 4.6% of patients (n = 11), with no statistically significant differences between the ESV and MCRS. In conclusion, new-onset LBBB is a frequent intraventricular conduction disturbance after TAVI with a higher incidence with the MCRS compared with the ESV. LBBB persists in most patients, but in this cohort, it was not a predictor of overall or cardiovascular mortality or permanent pacemaker implantation.

Original languageEnglish (US)
Pages (from-to)554-559
Number of pages6
JournalAmerican Journal of Cardiology
Volume112
Issue number4
DOIs
StatePublished - Aug 15 2013
Externally publishedYes

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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