Sven Knecht1,2,3,4, Beat Schaer5,2, Tobias Reichlin2,6,3,4, Florian Spies1,2,3,4, Antonio Madaffari1,2,3,4, Annina S. Vischer1,7,3,4, Gregor Fahrni1,2,3,4, Raban Jeger1,2,3,4, Christoph Kaiser1,2,3,4, Stefan Osswald1,2,3,4, Christian Sticherling1,2,3,4, Michael Kühne1,2,3,4
1Bern University Hospital, University of Bern, Switzerland
2Cardiovascular Research Institute Basel University Hospital Basel University Basel Basel Switzerland
3Medical Outpatient Department (A.V.), University Hospital Basel, University Basel, Basel, Switzerland; Depart-ment of Cardiology, Inselspital,
4University Hospital Basel, Basel, Switzerland
5Cardiology/Electrophysiology University Hospital Basel University Basel Basel Switzerland
6Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Switzerland
7Cardiovascular Research Institute Basel (
Tóm tắt
Background
Left bundle branch block (
LBBB
) is common after transcatheter aortic valve implantation (
TAVI
) and is an indicator of subsequent high‐grade atrioventricular block (
HAVB
). No standardized protocol is available to identify
LBBB
patients at risk for
HAVB
. The aim of the current study was to evaluate the safety and efficacy of an electrophysiology study tailored strategy in patients with
LBBB
after
TAVI
.
Methods and Results
We prospectively analyzed consecutive patients with
LBBB
after
TAVI
. An electrophysiology study was performed to measure the
HV
‐interval the day following
TAVI
. In patients with normal His‐ventricular (
HV
)‐interval ≤55 ms, a loop recorder was implanted (
ILR
‐group), whereas pacemaker implantation was performed in patients with prolonged
HV
‐interval >55 ms (
PM
‐group). The primary end point was occurrence of
HAVB
during a follow‐up of 12 months. Secondary end points were symptoms, hospitalizations, adverse events because of device implantation or electrophysiology study, and death. Of 373 patients screened after
TAVI
, 56 patients (82±6 years, 41% male) with
LBBB
were included.
HAVB
occurred in 4 of 41 patients (10%) in the
ILR
‐group and in 8 of 15 patients (53%) in the
PM
‐group (
P
<0.001). We did not identify other predictors for
HAVB
than the
HV
interval. The negative predictive value for the cut‐off of
HV
55 ms to detect
HAVB
was 90%. No
HAVB
‐related syncope occurred in the 2 groups.
Conclusions
An electrophysiology study tailored strategy to
LBBB
after
TAVI
with a cut‐off of
HV
>55 ms is a feasible and safe approach to stratify patients with regard to developing
HAVB
during a follow‐up of 12 months.
