Arrhythmic burden in patients with new-onset persistent left bundle branch block after transcatheter aortic valve replacement: 2-year results of the MARE study
Por:
Muntane-Carol, G, Urena, M, Nombela-Franco, L, Amat-Santos, I, Kleiman, N, Munoz-Garcia, A, Atienza, F, Serra, V, Deyell, MW, Veiga-Fernandez, G, Masson, JB, Canadas-Godoy, V, Himbert, D, Castrodeza, J, Elizaga, J, Pascual, JF, Webb, JG, Hernandez, JMD, Asmarats, L, Pelletier-Beaumont, E, Philippon, F, Rodes-Cabau, J
Publicada:
1 feb 2021
Resumen:
Aims We determined the incidence and type of arrhythmias at 2-year follow-up in patients with new-onset persistent left bundle branch block (LBBB) following transcatheter aortic valve replacement (TAVR).
Methods and results Multicentre prospective study including 103 consecutive patients with new-onset persistent LBBB post-TAVR (SAPIEN XT/3: 53; CoreValve/Evolut R: 50). An implantable cardiac monitor (Reveal XT, Reveal Linq) was implanted before hospital discharge and patients had continuous monitoring for up to 2 years. Arrhythmic events were adjudicated in a central core lab. 1836 new arrhythmic events (tachyarrhythmias: 1655 and bradyarrhythmias: 181) occurred at 2 years. Of these, 283 (15%) occurred beyond 1 year (tachyarrhythmias 212, bradyarrhythmias 71) in 33 (36%) patients, without differences between valve type. Most late (>1 year) arrhythmic events were asymptomatic (94%) and led to a treatment change in 17 (19%) patients. A total of 71 late bradyarrhythmias [highdegree atrioventricular block (HAVB): 3, severe bradycardia: 68] were detected in 17 (21%) patients. At 2 years, 18 (17%) patients had received a permanent pacemaker (PPM) or implantable cardiac-defibrillator. PPM implantation due to HAVB predominated in the early phase post-TAVR, with only 1 HAVB event requiring PPM implantation after 1 year.
Conclusion Patients with new-onset LBBB post-TAVR exhibited a very high burden of arrhythmic events within the 2 years post-procedure. While new tachyarrhythmic events were homogeneously distributed over time, the vast majority of new HAVB episodes leading to PPM implantation occurred early after the procedure. These results should help to guide the management of this challenging group of patients.
Filiaciones:
Muntane-Carol, G:
Laval Univ, Quebec Heart & Lung Inst, Dept Cardiol, 2725 Ch Ste Foy, Quebec City, PQ G1V 4G5, Canada
Urena, M:
Hop Bichat Claude Bernard, Assistance Publ Hop Paris, Dept Cardiol, Paris, France
Nombela-Franco, L:
Hosp Clin San Carlos, Inst Cardiovasc, Dept Cardiol, IdISSC, Madrid, Spain
Amat-Santos, I:
Hosp Univ Valladolid, Dept Cardiol, Valladolid, Spain
Kleiman, N:
Houston Methodist DeBakey Heart & Vasc Ctr, Dept Cardiol, Houston, TX USA
Munoz-Garcia, A:
Hosp Virgen de la Victoria, Dept Cardiol, Malaga, Spain
Atienza, F:
Hosp Gen Univ Gregorio Maranon, Dept Cardiol, Madrid, Spain
Serra, V:
Hosp Univ Vall dHebron, Dept Cardiol, Barcelona, Spain
Deyell, MW:
Univ British Columbia, Div Cardiol, St Pauls Hosp, Vancouver, BC, Canada
Univ British Columbia, Ctr Cardiovasc Innovat, St Pauls Hosp, Vancouver, BC, Canada
Veiga-Fernandez, G:
Hosp Marques de Valdecilla, Dept Cardiol, Santander, Spain
Masson, JB:
Ctr Hosp Univ Montreal, Dept Cardiol, Montreal, PQ, Canada
Canadas-Godoy, V:
Hosp Clin San Carlos, Inst Cardiovasc, Dept Cardiol, IdISSC, Madrid, Spain
Himbert, D:
Hop Bichat Claude Bernard, Assistance Publ Hop Paris, Dept Cardiol, Paris, France
Castrodeza, J:
Hosp Univ Valladolid, Dept Cardiol, Valladolid, Spain
Elizaga, J:
Hosp Gen Univ Gregorio Maranon, Dept Cardiol, Madrid, Spain
Pascual, JF:
Hosp Univ Vall dHebron, Dept Cardiol, Barcelona, Spain
Webb, JG:
Univ British Columbia, Div Cardiol, St Pauls Hosp, Vancouver, BC, Canada
Univ British Columbia, Ctr Cardiovasc Innovat, St Pauls Hosp, Vancouver, BC, Canada
Hernandez, JMD:
Hosp Marques de Valdecilla, Dept Cardiol, Santander, Spain
Asmarats, L:
Laval Univ, Quebec Heart & Lung Inst, Dept Cardiol, 2725 Ch Ste Foy, Quebec City, PQ G1V 4G5, Canada
Institut d’Investigació Biomèdica Sant Pau (IIB SANT PAU), Sant Quintí 77-79, 08041 Barcelona, Spain
Pelletier-Beaumont, E:
Laval Univ, Quebec Heart & Lung Inst, Dept Cardiol, 2725 Ch Ste Foy, Quebec City, PQ G1V 4G5, Canada
Philippon, F:
Laval Univ, Quebec Heart & Lung Inst, Dept Cardiol, 2725 Ch Ste Foy, Quebec City, PQ G1V 4G5, Canada
Rodes-Cabau, J:
Laval Univ, Quebec Heart & Lung Inst, Dept Cardiol, 2725 Ch Ste Foy, Quebec City, PQ G1V 4G5, Canada
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