Clinical implications of new-onset left bundle branch block after transcatheter aortic valve replacement: analysis of the PARTNER experience
Clinical implications of new-onset left bundle branch block after transcatheter aortic valve replacement: analysis of the PARTNER experience
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DOI：
10.1093/eurheartj/eht376
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发表时间：
2014-06-01
影响因子：
39.3
通讯作者：
Kodali, Susheel K.
中科院分区：
文献类型：
--
作者：
Nazif, Tamim M.;Williams, Mathew R.;Kodali, Susheel K.
目的心脏传导障碍，包括左束支分支传导阻滞（LBBB），在经导管主动脉瓣置换术（TAVR）后频繁发生，可能与不良临床事件相关。本分析探讨了新的发病率和影响，持续LBBB在接受TAVR与球囊扩张valve.Methods和结果的患者接受TAVR的放置主动脉经导管瓣膜（PARTNER）试验和继续访问注册与基线和出院/7天心电图的患者。既往永久性起搏器植入（PPI）和基线心室内传导异常是排除标准。确定了新发LBBB的预测因素，并比较了有无新发LBBB患者的结局。1151例患者中有121例（10.5%）发生了新发LBBB，其中一半以上持续6个月至1年。新发LBBB的唯一预测因素是既往冠状动脉旁路移植术。新发LBBB与1年死亡率、心血管死亡率、重复住院、卒中或心肌梗死无显著差异。然而，它与住院期间（8.3 vs 2.8%，P = 0.005）和出院至1年（4.7 vs 1.5%，P = 0.01）的PPI升高相关。新发LBBB患者TAVR后射血分数未改善，6个月至1年时仍较低（52.8% vs. 58.1%，P < 0.001）。结论PARTNER经验中，10.5%接受TAVR的无心室内基线传导的患者发生持续性新发LBBB。新发LBBB与1年时的死亡、再次住院、卒中或心肌梗死无关，但与PPI发生率较高和左心室射血分数未能改善相关。
Aims Cardiac conduction disturbances, including a left bundle branch block (LBBB), occur frequently following transcatheter aortic valve replacement (TAVR) and may be associated with adverse clinical events. This analysis examines the incidence and implications of new onset, persistent LBBB in patients undergoing TAVR with a balloon-expandable valve.Methods and results Patients undergoing TAVR in the Placement of Aortic Transcatheter Valves (PARTNER) trial and continued access registries with baseline and discharge/7-day electrocardiograms were included. Prior permanent pacemaker implantation (PPI) and baseline intraventricular conduction abnormalities were exclusion criteria. Predictors of new LBBB were identified and outcomes compared between patients with and without new LBBB. New LBBB occurred in 121 of 1151 (10.5%) patients and persisted in more than half at 6 months to 1 year. The only predictor of new LBBB was prior coronary artery bypass grafting. New LBBB was not associated with significant differences in 1-year mortality, cardiovascular mortality, repeat hospitalization, stroke, or myocardial infarction. However, it was associated with increased PPI during hospitalization (8.3 vs 2.8%, P = 0.005) and from discharge to 1 year (4.7 vs. 1.5%, P = 0.01). The ejection fraction failed to improve after TAVR in patients with new LBBB and remained lower at 6 months to 1 year (52.8 vs. 58.1%, P < 0.001).Conclusion Persistent, new-onset LBBB occurred in 10.5% of patients without intraventricular baseline conduction who underwent TAVR in the PARTNER experience. New LBBB was not associated with death, repeat hospitalization, stroke, or myocardial infarction at 1 year, but was associated with a higher rate of PPI and failure of left ventricular ejection fraction to improve.