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 ( P <0.001). We did not identify other predictors for HAVB than the HV interval. The negative predictive value for the cut‐off of HV 55 ms to detect HAVB was 90%. No HAVB ‐related syncope occurred in the 2 groups. Conclusions An electrophysiology study tailored strategy to LBBB after TAVI with a cut‐off of HV >55 ms is a feasible and safe approach to stratify patients with regard to developing HAVB during a follow‐up of 12 months.