Occurrence and Persistency of Conduction Disturbances during Transcatheter Aortic Valve Implantation
<i>Background and Objectives</i>: Conduction disturbances such as left bundle branch block (LBBB) and complete atrio-ventricular block (cAVB) are relatively frequent complications following trans-catheter aortic valve implantation (TAVI). We investigated the dynamics of these conduction...
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| Format: | Article |
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MDPI AG
2021-07-01
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| Series: | Medicina |
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| Online Access: | https://www.mdpi.com/1648-9144/57/7/695 |
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| author | Thomas T. Poels Elien B. Engels Suzanne Kats Leo Veenstra Vincent van Ommen Kevin Vernooy Jos G. Maessen Frits W. Prinzen |
| author_facet | Thomas T. Poels Elien B. Engels Suzanne Kats Leo Veenstra Vincent van Ommen Kevin Vernooy Jos G. Maessen Frits W. Prinzen |
| author_sort | Thomas T. Poels |
| collection | DOAJ |
| description | <i>Background and Objectives</i>: Conduction disturbances such as left bundle branch block (LBBB) and complete atrio-ventricular block (cAVB) are relatively frequent complications following trans-catheter aortic valve implantation (TAVI). We investigated the dynamics of these conduction blocks to further understand luxating factors and predictors for their persistency. <i>Materials and Methods</i>: We prospectively included 157 consecutive patients who underwent a TAVI procedure. Electrocardiograms (ECGs) were obtained at specific time points during the TAVI procedure and at follow-up until at least six months post-procedure. <i>Results:</i> Of the 106 patients with a narrow QRS complex (nQRS) before TAVI, ~70% developed LBBB; 28 (26.4%) being classified as super-transient (ST-LBBB), 20 (18.9%) as transient (T-LBBB) and 24 (22.6%) as persistent (P-LBBB). Risk of LBBB was higher for self-expandable (SE) than for balloon-expandable (BE) prostheses and increased with larger implant depth. During the TAVI procedure conduction disturbances showed a dynamic behavior, as illustrated by alternating kinds of blocks in 18 cases. Most LBBBs developed during balloon aortic valvuloplasty (BAV) and at positioning and deployment of the TAVI prosthesis. The incidence of LBBB was not significantly different between patients who did and did not undergo BAV prior to TAVI implantation (65.3% and 74.2%, respectively (<i>p</i> = 0.494)). Progression to cAVB was most frequent for patients with preexisting conduction abnormalities (5/34) patients) and in patients showing ST-LBBB (6/28). <i>Conclusions</i>: During the TAVI procedure, conduction disturbances showed a dynamic behavior with alternating types of block in 18 cases. After a dynamic period of often alternating types of block, most BBBs are reversible while one third persist. Patients with ST-LBBB are most prone to progressing into cAVB. The observation that the incidence of developing LBBB after TAVI is similar with and without BAV suggests that a subgroup of patients has a substrate to develop LBBB regardless of the procedure. |
| first_indexed | 2024-03-10T09:32:53Z |
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| issn | 1010-660X 1648-9144 |
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| spelling | doaj.art-e8335b967d6249f3a18cfe0e19bf68de2023-11-22T04:21:15ZengMDPI AGMedicina1010-660X1648-91442021-07-0157769510.3390/medicina57070695Occurrence and Persistency of Conduction Disturbances during Transcatheter Aortic Valve ImplantationThomas T. Poels0Elien B. Engels1Suzanne Kats2Leo Veenstra3Vincent van Ommen4Kevin Vernooy5Jos G. Maessen6Frits W. Prinzen7Department of Cardiothoracic Surgery, Maastricht University Medical Center, P.O. Box 5800 Maastricht, The NetherlandsDepartment of Physiology, Faculty of Health, Medicine and Life Sciences, CARIM School for Cardiovascular Diseases, P.O. Box 616 Maastricht, The NetherlandsDepartment of Cardiothoracic Surgery, Maastricht University Medical Center, P.O. Box 5800 Maastricht, The NetherlandsDepartment of Cardiology, Maastricht University Medical Center, P.O. Box 5800 Maastricht, The NetherlandsDepartment of Cardiology, Maastricht University Medical Center, P.O. Box 5800 Maastricht, The NetherlandsDepartment of Cardiology, Maastricht University Medical Center, P.O. Box 5800 Maastricht, The NetherlandsDepartment of Cardiothoracic Surgery, Maastricht University Medical Center, P.O. Box 5800 Maastricht, The NetherlandsDepartment of Physiology, Faculty of Health, Medicine and Life Sciences, CARIM School for Cardiovascular Diseases, P.O. Box 616 Maastricht, The Netherlands<i>Background and Objectives</i>: Conduction disturbances such as left bundle branch block (LBBB) and complete atrio-ventricular block (cAVB) are relatively frequent complications following trans-catheter aortic valve implantation (TAVI). We investigated the dynamics of these conduction blocks to further understand luxating factors and predictors for their persistency. <i>Materials and Methods</i>: We prospectively included 157 consecutive patients who underwent a TAVI procedure. Electrocardiograms (ECGs) were obtained at specific time points during the TAVI procedure and at follow-up until at least six months post-procedure. <i>Results:</i> Of the 106 patients with a narrow QRS complex (nQRS) before TAVI, ~70% developed LBBB; 28 (26.4%) being classified as super-transient (ST-LBBB), 20 (18.9%) as transient (T-LBBB) and 24 (22.6%) as persistent (P-LBBB). Risk of LBBB was higher for self-expandable (SE) than for balloon-expandable (BE) prostheses and increased with larger implant depth. During the TAVI procedure conduction disturbances showed a dynamic behavior, as illustrated by alternating kinds of blocks in 18 cases. Most LBBBs developed during balloon aortic valvuloplasty (BAV) and at positioning and deployment of the TAVI prosthesis. The incidence of LBBB was not significantly different between patients who did and did not undergo BAV prior to TAVI implantation (65.3% and 74.2%, respectively (<i>p</i> = 0.494)). Progression to cAVB was most frequent for patients with preexisting conduction abnormalities (5/34) patients) and in patients showing ST-LBBB (6/28). <i>Conclusions</i>: During the TAVI procedure, conduction disturbances showed a dynamic behavior with alternating types of block in 18 cases. After a dynamic period of often alternating types of block, most BBBs are reversible while one third persist. Patients with ST-LBBB are most prone to progressing into cAVB. The observation that the incidence of developing LBBB after TAVI is similar with and without BAV suggests that a subgroup of patients has a substrate to develop LBBB regardless of the procedure.https://www.mdpi.com/1648-9144/57/7/695transcatheter aortic valve implantationleft bundle branch blockelectrocardiogram |
| spellingShingle | Thomas T. Poels Elien B. Engels Suzanne Kats Leo Veenstra Vincent van Ommen Kevin Vernooy Jos G. Maessen Frits W. Prinzen Occurrence and Persistency of Conduction Disturbances during Transcatheter Aortic Valve Implantation Medicina transcatheter aortic valve implantation left bundle branch block electrocardiogram |
| title | Occurrence and Persistency of Conduction Disturbances during Transcatheter Aortic Valve Implantation |
| title_full | Occurrence and Persistency of Conduction Disturbances during Transcatheter Aortic Valve Implantation |
| title_fullStr | Occurrence and Persistency of Conduction Disturbances during Transcatheter Aortic Valve Implantation |
| title_full_unstemmed | Occurrence and Persistency of Conduction Disturbances during Transcatheter Aortic Valve Implantation |
| title_short | Occurrence and Persistency of Conduction Disturbances during Transcatheter Aortic Valve Implantation |
| title_sort | occurrence and persistency of conduction disturbances during transcatheter aortic valve implantation |
| topic | transcatheter aortic valve implantation left bundle branch block electrocardiogram |
| url | https://www.mdpi.com/1648-9144/57/7/695 |
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