TY - JOUR
T1 - Arrhythmic burden in patients with new-onset persistent left bundle branch block after transcatheter aortic valve replacement
T2 - 2-year results of the MARE study
AU - Muntané-Carol, Guillem
AU - Urena, Marina
AU - Nombela-Franco, Luis
AU - Amat-Santos, Ignacio
AU - Kleiman, Neal
AU - Munoz-Garcia, Antonio
AU - Atienza, Felipe
AU - Serra, Vicenç
AU - Deyell, Marc W.
AU - Veiga-Fernandez, Gabriela
AU - Masson, Jean Bernard
AU - Canadas-Godoy, Victoria
AU - Himbert, Dominique
AU - Castrodeza, Javier
AU - Elizaga, Jaime
AU - Francisco Pascual, Jaume
AU - Webb, John G.
AU - De La Torre Hernandez, Jose M.
AU - Asmarats, Lluis
AU - Pelletier-Beaumont, Emilie
AU - Philippon, Francois
AU - Rodés-Cabau, Josep
N1 - Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2020. For permissions, please email: journals.permissions@oup.com.
PY - 2021/2/1
Y1 - 2021/2/1
N2 - 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 [high-degree 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. (clinicaltrials.gov: NCT02153307)
AB - 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 [high-degree 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. (clinicaltrials.gov: NCT02153307)
KW - Atrial fibrillation
KW - Bradyarrhythmias
KW - Left bundle branch block
KW - Pacemaker implantation
KW - Transcatheter aortic valve replacement
KW - Prospective Studies
KW - Humans
KW - Risk Factors
KW - Transcatheter Aortic Valve Replacement/adverse effects
KW - Treatment Outcome
KW - Pacemaker, Artificial
KW - Bundle-Branch Block/diagnosis
KW - Aortic Valve Stenosis/surgery
KW - Aortic Valve/diagnostic imaging
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UR - http://www.scopus.com/inward/citedby.url?scp=85102091007&partnerID=8YFLogxK
U2 - 10.1093/europace/euaa213
DO - 10.1093/europace/euaa213
M3 - Article
C2 - 33083813
AN - SCOPUS:85102091007
SN - 1099-5129
VL - 23
SP - 254
EP - 263
JO - Europace
JF - Europace
IS - 2
ER -