Author + information
- Received February 5, 2018
- Revision received March 26, 2018
- Accepted April 10, 2018
- Published online July 18, 2018.
- Josep Rodés-Cabau, MDa,∗ (, )
- Marina Urena, MD, PhDb,
- Luis Nombela-Franco, MD, PhDc,
- Ignacio Amat-Santos, MD, PhDd,
- Neal Kleiman, MDe,
- Antonio Munoz-Garcia, MD, PhDf,
- Felipe Atienza, MD, PhDg,
- Vicenç Serra, MDh,
- Marc W. Deyell, MDi,
- Gabriela Veiga-Fernandez, MDj,
- Jean-Bernard Masson, MDk,
- Victoria Canadas-Godoy, MDc,
- Dominique Himbert, MDb,
- Javier Castrodeza, MDd,
- Jaime Elizaga, MDg,
- Jaume Francisco Pascual, MDh,
- John G. Webb, MDi,
- Jose Maria de la Torre, MDj,
- Lluis Asmarats, MDa,
- Emilie Pelletier-Beaumont, MSca and
- François Philippon, MDa
- aDepartment of Cardiology, Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
- bDepartment of Cardiology, Assistance Publique-Hôpitaux de Paris, Höpital Bichat-Claude Bernard, Paris, France
- cInstituto Cardiovascular, Hospital Clinico San Carlos, IdISSC, Madrid, Spain
- dDepartment of Cardiology, Hospital Universitario de Valladolid, Valladolid, Spain
- eDepartment of Cardiology, Hospital Virgen de la Victoria, Málaga, Spain
- fDepartment of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas
- gDepartment of Cardiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- hDepartment of Cardiology, Hospital Universitari Vall d’Hebron, Barcelona, Spain
- iDepartment of Cardiology, St Paul’s Hospital, Vancouver, British Columbia, Canada
- jDepartment of Cardiology, Hospital Marques de Valdecilla, Santander, Spain
- kDepartment of Cardiology, Centre Hospitalier Universitaire de Montreal, Montreal, Quebec, Canada
- ↵∗Address for correspondence:
Dr. Josep Rodés-Cabau, Quebec Heart & Lung Institute, Laval University, 2725 chemin Ste-Foy, G1V4G5 Quebec City, Quebec, Canada.
Objectives The authors sought to determine: 1) the global arrhythmic burden; 2) the rate of arrhythmias leading to a treatment change; and 3) the incidence of high-degree atrioventricular block (HAVB) at 12-month follow-up in patients with new-onset persistent left bundle branch block (LBBB) following transcatheter aortic valve replacement (TAVR).
Background Controversial data exist on the occurrence of significant arrhythmias in patients with LBBB post-TAVR.
Methods This was a multicenter prospective study including 103 consecutive patients with new-onset persistent LBBB post-TAVR with the balloon-expandable SAPIEN XT/3 valve (n = 53), or the self-expanding CoreValve/Evolut R system (n = 50). An implantable cardiac monitor (Reveal XT, Reveal Linq) was implanted at 4 (3 to 6) days post-TAVR, and patients had continuous electrocardiogram monitoring for 12 months. All arrhythmic events were adjudicated in a central electrocardiography core lab. Primary endpoints were the incidence of arrhythmias leading to a treatment change, and the incidence of HAVB at 12-month follow-up.
Results A total of 1,553 new arrhythmic events were detected in 44 patients (1,443 episodes of tachyarrhythmia in 26 patients [atrial fibrillation/flutter/atrial tachycardia: 1,427, ventricular tachycardia 16]; 110 episodes of bradyarrhythmia in 21 patients [HAVB 54, severe bradycardia 56]). All arrhythmic events were silent in 34 patients (77%), the arrhythmic event led to a treatment change in 19 patients (18%), and 11 patients (11%) required pacemaker or implantable cardioverter-defibrillator implantation (due to HAVB, severe bradycardia, or ventricular tachycardia episodes in 9, 1, and 1 patient, respectively). A total of 12 patients died at 1-year follow-up, 1 from sudden death.
Conclusions A high incidence of arrhythmic events was observed at 1-year follow-up in close to one-half of the patients with LBBB post-TAVR. Significant bradyarrhythmias occurred in one-fifth of the patients, and PPM was required in nearly one-half of them. These data support the use of a cardiac monitoring device for close follow-up and expediting the initiation of treatment in this challenging group of patients. (Ambulatory Electrocardiographic Monitoring for the Detection of High-Degree Atrio-Ventricular Block in Patients With New-onset PeRsistent LEft Bundle Branch Block After Transcatheter Aortic Valve Implantation [MARE study]: NCT02153307)
- atrial fibrillation
- left bundle branch block
- pacemaker implantation
- transcatheter aortic valve replacement
Dr. Asmarats is supported by a grant from the Fundacion Alfonso Martin Escudero (Madrid, Spain). Dr. Rodés-Cabau holds the Canadian Research Chair “Fondation Famille Jacques Larivière” for the Development of Structural Heart Disease Interventions; and has received research institutional grants from Medtronic and Edwards Lifesciences. Dr. Nombela-Franco has served as a proctor for Abbott; and has received speaker honoraria from Edwards Lifesciences. Dr. Amat-Santos has been a proctor for Boston Scientific. Dr. Atienza has served on advisory boards for Medtronic. Dr. Deyell has received research funding from Biosense Webster; and speaking honoraria from Abbott Medical. Dr. Himbert has been a consultant and proctor for Edwards Lifesciences. Dr. Webb has been a consultant for Edwards Lifesciences. Dr. de la Torre has served on advisory boards for Medtronic and Boston Scientific. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received February 5, 2018.
- Revision received March 26, 2018.
- Accepted April 10, 2018.
- 2018 American College of Cardiology Foundation
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