Electrophysiology Testing to Stratify Patients With Left Bundle Branch Block After Transcatheter Aortic Valve Implantation

Abstract

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 (P55 ms is a feasible and safe approach to stratify patients with regard to developing HAVB during a follow‐up of 12 months.

Keywords

• electrophysiology study
• high‐grade AV block
• left bundle branch block
• transaortic valve implantation