Predicting Left Bundle Branch Block Occurence Post TAVI: Four Major Factors And Their Combination

Vassileios Voudris Cardiology, Onassis Cardiac Surgery, Athens, Attiki, Greece Nikolaos Aravanis Cardiology, Onassis Cardiac Surgery, Athens, Attiki, Greece Ilias Kosmas Cardiology, Onassis Cardiac Surgery, Athens, Attiki, Greece Evangelos Leontiadis Cardiology, Onassis Cardiac Surgery, Athens, Attiki, Greece Eftychia Sbarouni Cardiology, Onassis Cardiac Surgery, Athens, Attiki, Greece Marina Mpalanika Anaesthesiology, Onassis Cardiac Surgery, Athens, Attiki, Greece Ioannis Iakovou Cardiology, Onassis Cardiac Surgery, Athens, Attiki, Greece

For patients undergoing a transcatheter aortic valve implantation(TAVI), our hospital analyzed four key factors, including the anatomy and calcification of left ventricular outflow tract from CT angiography, the implantation depth during the procedure, and the need for pre and postTAVI dialatation, as major predictive values in the presence of persistent new onset left bundle branch block (LBBB) post TAVI.

After the exclusion of 60 patients due to having either pre-existing LBBB or a permanent pacemaker implantation, 23 of the remaining 126 patients were discharged with new onset LBBB (18,2%). Four groups of patients were further studied: 17 patients with a high degree of calcification(Group A), 26 with high implantation depth>6mm(Group B), 31 with preTAVI dilatation(Group C) and 17 with postTAVI dilatation(Group D). The probability of having new onset LBBB was greater for all groups and with statistical significance for three of the four groups(A,B,D). When combining the two strongest factors (high calcium and implantation depth), all 3 patients(100%) developed new onset LBBB. Likewise, when combining deep implantation, pre, and postTAVI,again all 3 patients(100%) also developed new onset LBBB. Finally,new onset LBBB was also observed in 60%. 71,4% and 80% of the patients belonging in both Groups A&D, B&D,and B&C respectively.

Our study has demonstrated that when these factor are combined, the probabilities for new onset LBBB occuring increases. It is crucial to avoid the combination of these factors, especially in high calcium score patients, to reduce the appearance of this conduction abnormality.