Transcatheter Aortic Valve Implantation-Induced Left Bundle Branch Block: Causes and Consequences

  • Thomas T. Poels
  • Patrick Houthuizen
  • Leen A. F. M. Van Garsse
  • Jos G. Maessen
  • Peter de Jaegere
  • Frits W. Prinzen
Article

DOI: 10.1007/s12265-014-9560-x

Cite this article as:
Poels, T.T., Houthuizen, P., Van Garsse, L.A.F.M. et al. J. of Cardiovasc. Trans. Res. (2014) 7: 395. doi:10.1007/s12265-014-9560-x

Abstract

Transcatheter aortic valve implantation (TAVI) is an alternative treatment option for patients with severe aortic valve stenosis who do not qualify for surgical aortic valve replacement (AVR). Besides its proven clinical benefits, one of the complications of TAVI is the creation of conduction abnormalities, like left bundle branch block (LBBB). New LBBB occurs between 7 and 65 % of cases, numbers that differ considerably between devices. In this review, we discuss the possible causes and the clinical significance of TAVI-induced LBBB. Several device- and procedural-related factors seem responsible for the development of LBBB, of which depth of implantation and balloon-annulus diameter ratio are the most important ones. TAVI-induced LBBB negatively affects cardiac function and hospitalization, but its impact on mortality is subject of debate. Future research and registries should implement strict diagnostic criteria for LBBB together with recording of its timing and persistence.

Keywords

Transcatheter aortic valve implantation TAVI Left bundle branch block LBBB 

Abbreviations

AOV

Aortic valve

AV

Atrioventricular

AVB

Atrioventricular block

AVR

Surgical aortic valve replacement

BAV

Balloon aortic valvuloplasty

CI

Confidence interval

CRT

Cardiac resynchronization therapy

ECG

Electrocardiogram

ES

Edwards Sapien prosthesis

HB

His bundle

HR

Hazard ratio

IVS

Interventricular septum

LAO

Left anterior oblique

LBB

Left bundle branch

LBBB

Left bundle branch block

LFT

Left fibrous trigone

LV

Left ventricular

LVEF

Left ventricular ejection fraction

ΔLVEF

Difference in left ventricular ejection fraction (LVEF follow-up − LVEF baseline).

LVOT

Left ventricular outflow tract

MCS

Medtronic CoreValve System prosthesis

MS

Membraneous septum

MV

Mitral valve

N/A

Not available

NCC

Non coronary cusp

PPM

Postoperative permanent pacemaker

RBB

Right bundle branch

RBBB

Right bundle branch block

RFT

Right fibrous trigone

RR

Relative risk

RV

Right ventricular

STJ

Sinotubular junction

TAVI

Transcatheter aortic valve implantation

TEE

Transesophageal echocardiogram

VCD

Ventricular conduction disorder

VS

Ventricular septum

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Thomas T. Poels
    • 1
  • Patrick Houthuizen
    • 2
  • Leen A. F. M. Van Garsse
    • 1
  • Jos G. Maessen
    • 1
  • Peter de Jaegere
    • 3
  • Frits W. Prinzen
    • 4
  1. 1.Department of Cardiothoracic SurgeryMaastricht University Medical CenterMaastrichtThe Netherlands
  2. 2.Catharina HospitalEindhovenThe Netherlands
  3. 3.Erasmus Medical CenterRotterdamThe Netherlands
  4. 4.Cardiovascular Research Institute MaastrichtMaastrichtThe Netherlands

Personalised recommendations