Risk factors and prognosis of new-onset conduction block following transcatheter aortic valve implantation_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LIN Wenbao ¹ , ZHENG Ke’er ¹ , CHEN Haiyu ² , ZHENG Fuzhen ² ,  WENG Guoxing ² , CHEN Xinjing ²

1. Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, P. R. China;
2. Cardiovascular Disease Research Center, Fujian Provincial Hospital, Fuzhou, 350001, P. R. China;

Corresponding author：

WENG Guoxing, Email: gxw00120@sina.com

Keywords：

Transcatheter aortic valve implantation (TAVI); left bundle branch block; complete atrioventricular block; permanent pacemaker implantation

DOI：

10.7507/1007-4848.202201087

Video：

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Objective To analyze predictive factors, clinical implications and prognosis effects of new-onset conduction block after transcatheter aortic valve implantation (TAVI). Methods The clinical data of 86 patients who underwent TAVI through transfemoral approach from 2019 to 2021 in Fujian Provincial Hospital were retrospectively analyzed, including 59 males and 27 females with an average age of 72.9±8.0 years. The patients were divided into a normal group and a new-onset conduction block group according to whether there was new-onset conduction block after operation, and then the new-onset conduction block group was subdivided into a left bundle branch block (LBBB) group (28 patients) and a complete atrioventricular block (CAVB) group (11 patients). We compared the hemodynamics and TAVI-related complications between the postoperative and early follow-up periods, and used the multivariate logistic regression models to identify risk factors for the new-onset conduction block. Results The median EuroSCORE of all patients were 8 (2) points before the operation. In the postoperative and early follow-up periods, the hemodynamics and TAVI-related complications had no statistical difference between the new-onset conduction block group and the normal group (P>0.05). The incidence of permanent pacemaker implantation (81.8%, 9/11) and mortality due to cardiac causes (18.1%, 2/11) in the CAVB group were significantly higher than those in the normal group and theLBBB group (P<0.05). Female, severe calcification of the aortic valve, too large valve size and deep valve implants were the risk factors for new-onset conduction block after TAVI. Conclusion The incidence of LBBB and CAVB is high after TAVI, however, both of them do not significantly effect the hemodynamics of the patients. Higher incidence of permanent pacemaker implantation is found in the CAVB group which affects the rate of rehospitalization and mortality. Female patients, severe calcification of the aortic valve, too large valve size and deep valve implants are the risk factors for the new-onset conduction block after TAVI.

Citation： LIN Wenbao, ZHENG Ke’er, CHEN Haiyu, ZHENG Fuzhen, WENG Guoxing, CHEN Xinjing. Risk factors and prognosis of new-onset conduction block following transcatheter aortic valve implantation. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2022, 29(8): 977-985. doi: 10.7507/1007-4848.202201087 Copy

1.	Nazif TM, Williams MR, Hahn RT, et al. Clinical implications of new-onset left bundle branch block after transcatheter aortic valve replacement: Analysis of the PARTNER experience. Eur Heart J, 2014, 35(24): 1599-1607.
2.	Petronio AS, Sinning JM, Van Mieghem N, et al. Optimal implantation depth and adherence to guidelines on permanent pacing to improve the results of transcatheter aortic valve replacement with the Medtronic CoreValve system: The CoreValve prospective, international, post-market ADVANCE-Ⅱ study. JACC Cardiovasc Interv, 2015, 8(6): 837-846.
3.	De Torres-Alba F, Kaleschke G, Diller GP, et al. Changes in the pacemaker rate after transition from Edwards SAPIEN XT to SAPIEN 3 transcatheter aortic valve implantation: The critical role of valve implantation height. JACC Cardiovasc Interv, 2016, 9(8): 805-813.
4.	Urena M, Webb JG, Cheema A, et al. Impact of new-onset persistent left bundle branch block on late clinical outcomes in patients undergoing transcatheter aortic valve implantation with a balloon-expandable valve. JACC Cardiovasc Interv, 2014, 7(2): 128-136.
5.	Hein-Rothweiler R, Jochheim D, Rizas K, et al. Aortic annulus to left coronary distance as a predictor for persistent left bundle branch block after TAVI. Catheter Cardiovasc Interv, 2017, 89(4): E162-E168.
6.	Urena M, Mok M, Serra V, et al. Predictive factors and long-term clinical consequences of persistent left bundle branch block following transcatheter aortic valve implantation with a balloon-expandable valve. J Am Coll Cardiol, 2012, 60(18): 1743-1752.
7.	Nazif TM, Dizon JM, Hahn RT, et al. Predictors and clinical outcomes of permanent pacemaker implantation after transcatheter aortic valve replacement: The PARTNER (Placement of AoRtic TraNscathetER Valves) trial and registry. JACC Cardiovasc Interv, 2015, 8(1 Pt A): 60-69.
8.	Carrabba N, Valenti R, Migliorini A, et al. Impact on left ventricular function and remodeling and on 1-year outcome in patients with left bundle branch block after transcatheter aortic valve implantation. Am J Cardiol, 2015, 116(1): 125-131.
9.	Miura M, Shirai S, Uemura Y, et al. Clinical impact of intraventricular conduction abnormalities after transcatheter aortic valve implantation with balloon-expandable valves. Am J Cardiol, 2019, 123(2): 297-305.
10.	Faroux L, Chen S, Muntané-Carol G, et al. Clinical impact of conduction disturbances in transcatheter aortic valve replacement recipients: A systematic review and meta-analysis. Eur Heart J, 2020, 41(29): 2771-2781.
11.	张振华, 张海波, 李岳环, 等. 经导管主动脉瓣置入术围手术期新发心脏传导阻滞结果分析. 中华胸心血管外科杂志, 2020, 36(12): 716-720.
12.	Erkapic D, De Rosa S, Kelava A, et al. Risk for permanent pacemaker after transcatheter aortic valve implantation: A comprehensive analysis of the literature. J Cardiovasc Electrophysiol, 2012, 23(4): 391-397.
13.	Auffret V, Puri R, Urena M, et al. Conduction disturbances after transcatheter aortic valve replacement: Current status and future perspectives. Circulation, 2017, 136(11): 1049-1069.
14.	Fadahunsi OO, Olowoyeye A, Ukaigwe A, et al. Incidence, predictors, and outcomes of permanent pacemaker implantation following transcatheter aortic valve replacement: Analysis from the U. S. Society of Thoracic Surgeons/American College of Cardiology TVT Registry. JACC Cardiovasc Interv, 2016, 9(21): 2189-2199.
15.	Regueiro A, Abdul-Jawad Altisent O, Del Trigo M, et al. Impact of new-onset left bundle branch block and periprocedural permanent pacemaker implantation on clinical outcomes in patients undergoing transcatheter aortic valve replacement: A systematic review and meta-analysis. Circ Cardiovasc Interv, 2016, 9(5): e003635.
16.	Schymik G, Tzamalis P, Bramlage P, et al. Clinical impact of a new left bundle branch block following TAVI implantation: 1-year results of the TAVIK cohort. Clin Res Cardiol, 2015, 104(4): 351-362.
17.	Houthuizen P, Van Garsse LA, Poels TT, et al. Left bundle-branch block induced by transcatheter aortic valve implantation increases risk of death. Circulation, 2012, 126(6): 720-728.
18.	Aktug Ö, Dohmen G, Brehmer K, et al. Incidence and predictors of left bundle branch block after transcatheter aortic valve implantation. Int J Cardiol, 2012, 160(1): 26-30.
19.	Katsanos S, van Rosendael P, Kamperidis V, et al. Insights into new-onset rhythm conduction disorders detected by multi-detector row computed tomography after transcatheter aortic valve implantation. Am J Cardiol, 2014, 114(10): 1556-1561.
20.	Siontis GC, Jüni P, Pilgrim T, et al. Predictors of permanent pacemaker implantation in patients with severe aortic stenosis undergoing TAVR: A meta-analysis. J Am Coll Cardiol, 2014, 64(2): 129-140.
21.	Jilaihawi H, Zhao Z, Du R, et al. Minimizing permanent pacemaker following repositionable self-expanding transcatheter aortic valve replacement. JACC Cardiovasc Interv, 2019, 12(18): 1796-1807.

1. Nazif TM, Williams MR, Hahn RT, et al. Clinical implications of new-onset left bundle branch block after transcatheter aortic valve replacement: Analysis of the PARTNER experience. Eur Heart J, 2014, 35(24): 1599-1607.
2. Petronio AS, Sinning JM, Van Mieghem N, et al. Optimal implantation depth and adherence to guidelines on permanent pacing to improve the results of transcatheter aortic valve replacement with the Medtronic CoreValve system: The CoreValve prospective, international, post-market ADVANCE-Ⅱ study. JACC Cardiovasc Interv, 2015, 8(6): 837-846.
3. De Torres-Alba F, Kaleschke G, Diller GP, et al. Changes in the pacemaker rate after transition from Edwards SAPIEN XT to SAPIEN 3 transcatheter aortic valve implantation: The critical role of valve implantation height. JACC Cardiovasc Interv, 2016, 9(8): 805-813.
4. Urena M, Webb JG, Cheema A, et al. Impact of new-onset persistent left bundle branch block on late clinical outcomes in patients undergoing transcatheter aortic valve implantation with a balloon-expandable valve. JACC Cardiovasc Interv, 2014, 7(2): 128-136.
5. Hein-Rothweiler R, Jochheim D, Rizas K, et al. Aortic annulus to left coronary distance as a predictor for persistent left bundle branch block after TAVI. Catheter Cardiovasc Interv, 2017, 89(4): E162-E168.
6. Urena M, Mok M, Serra V, et al. Predictive factors and long-term clinical consequences of persistent left bundle branch block following transcatheter aortic valve implantation with a balloon-expandable valve. J Am Coll Cardiol, 2012, 60(18): 1743-1752.
7. Nazif TM, Dizon JM, Hahn RT, et al. Predictors and clinical outcomes of permanent pacemaker implantation after transcatheter aortic valve replacement: The PARTNER (Placement of AoRtic TraNscathetER Valves) trial and registry. JACC Cardiovasc Interv, 2015, 8(1 Pt A): 60-69.
8. Carrabba N, Valenti R, Migliorini A, et al. Impact on left ventricular function and remodeling and on 1-year outcome in patients with left bundle branch block after transcatheter aortic valve implantation. Am J Cardiol, 2015, 116(1): 125-131.
9. Miura M, Shirai S, Uemura Y, et al. Clinical impact of intraventricular conduction abnormalities after transcatheter aortic valve implantation with balloon-expandable valves. Am J Cardiol, 2019, 123(2): 297-305.
10. Faroux L, Chen S, Muntané-Carol G, et al. Clinical impact of conduction disturbances in transcatheter aortic valve replacement recipients: A systematic review and meta-analysis. Eur Heart J, 2020, 41(29): 2771-2781.
11. 张振华, 张海波, 李岳环, 等. 经导管主动脉瓣置入术围手术期新发心脏传导阻滞结果分析. 中华胸心血管外科杂志, 2020, 36(12): 716-720.
12. Erkapic D, De Rosa S, Kelava A, et al. Risk for permanent pacemaker after transcatheter aortic valve implantation: A comprehensive analysis of the literature. J Cardiovasc Electrophysiol, 2012, 23(4): 391-397.
13. Auffret V, Puri R, Urena M, et al. Conduction disturbances after transcatheter aortic valve replacement: Current status and future perspectives. Circulation, 2017, 136(11): 1049-1069.
14. Fadahunsi OO, Olowoyeye A, Ukaigwe A, et al. Incidence, predictors, and outcomes of permanent pacemaker implantation following transcatheter aortic valve replacement: Analysis from the U. S. Society of Thoracic Surgeons/American College of Cardiology TVT Registry. JACC Cardiovasc Interv, 2016, 9(21): 2189-2199.
15. Regueiro A, Abdul-Jawad Altisent O, Del Trigo M, et al. Impact of new-onset left bundle branch block and periprocedural permanent pacemaker implantation on clinical outcomes in patients undergoing transcatheter aortic valve replacement: A systematic review and meta-analysis. Circ Cardiovasc Interv, 2016, 9(5): e003635.
16. Schymik G, Tzamalis P, Bramlage P, et al. Clinical impact of a new left bundle branch block following TAVI implantation: 1-year results of the TAVIK cohort. Clin Res Cardiol, 2015, 104(4): 351-362.
17. Houthuizen P, Van Garsse LA, Poels TT, et al. Left bundle-branch block induced by transcatheter aortic valve implantation increases risk of death. Circulation, 2012, 126(6): 720-728.
18. Aktug Ö, Dohmen G, Brehmer K, et al. Incidence and predictors of left bundle branch block after transcatheter aortic valve implantation. Int J Cardiol, 2012, 160(1): 26-30.
19. Katsanos S, van Rosendael P, Kamperidis V, et al. Insights into new-onset rhythm conduction disorders detected by multi-detector row computed tomography after transcatheter aortic valve implantation. Am J Cardiol, 2014, 114(10): 1556-1561.
20. Siontis GC, Jüni P, Pilgrim T, et al. Predictors of permanent pacemaker implantation in patients with severe aortic stenosis undergoing TAVR: A meta-analysis. J Am Coll Cardiol, 2014, 64(2): 129-140.
21. Jilaihawi H, Zhao Z, Du R, et al. Minimizing permanent pacemaker following repositionable self-expanding transcatheter aortic valve replacement. JACC Cardiovasc Interv, 2019, 12(18): 1796-1807.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Risk factors and prognosis of new-onset conduction block following transcatheter aortic valve implantation

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