Research Article
Owais T, El-Garhy M, Abdulr
Abstract
Objective: LBBB is not a rare complication after TAVI. Available data on the reversibility of new-onset left bundlebranch block (LBBB) after transcatheter aortic valve replacement (TAVR) in relation to valve type and other factorsremain controversial. We aimed to find out factors that might be responsible for the reversibility of this complicationpost implantation.Method: In this retrospective observational study, we reviewed all TAVI patients operated in our institute from July2014 to July 2019. We included patients who developed new LBBB post TAVI and excluded patients with preexistingpacemaker, preoperative LBBB and patients requiring Permanent pacemaker post-operatively during the indexhospitalization. Twelve-lead electrocardiograms at baseline, immediately after TAVI and at 30-days follow-up wereevaluated. 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-dayfollow-up respectively. 40.1% showed persistent LBBB after 30 days without the need for pacemaker due toatrioventricular block during the follow up. Only one patient received a CRT pacemaker due to persistent LBBB andseverely reduced ejection fraction.Results: Reversibility of LBBB was documented in 14.3% of patients who received Sapien balloon expandablevalve, in 0% of patients with Core valves and in 66.7% patients with of Symetis valve. No patients had additionalconduction 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). Septalhypertrophy was more prominent in patients with irreversible LBBB (14 ± 2.6 vs. 13 ± 1.4, p-value 0.004). Annulusdiameter 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 werepredictive 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 30day follow-up with a relevant tendency to stabilization especially in patients without balloon predilataion and inpatients who received Symetis valve.