The following is a summary of “RISK STRATIFYING NEW-LEFT BUNDLE BRANCH BLOCK FOLLOWING TRANSCATHETER AORTIC VALVE REPLACEMENT WITH ELECTROPHYSIOLOGY STUDY FOR HIGH DEGREE ATRIOVENTRICULAR BLOCK – A PILOT STUDY,” published in the March 2023 issue of Cardiology by Patel, et al.

Patients undergoing transcatheter aortic valve replacement (TAVR) risk developing new conduction abnormalities, including left bundle branch block (LBBB). However, there needed to be more consensus on how to manage this risk. 

For a study, researchers sought to assess the risk of advanced conduction abnormalities in patients who develop new persistent LBBB after TAVR and to determine whether an electrophysiology study (EPS) could help with risk stratification.

From June 2020 to March 2022, the study included 160 patients who underwent TAVR, with 12 developing new persistent LBBB after the procedure. All patients underwent EPS (on post-TAVR day 1 for balloon-expanding valves and day 2 for self-expanding valves) to assess their HV interval. Patients with prior LBBB or other conduction abnormalities were excluded from the study. Of the 12 patients with new persistent LBBB, 8 with a normal EPS did not require a pacemaker at follow-up. One patient declined the EPS but did not require a pacemaker based on event monitoring. The remaining 3 patients had prolonged HV intervals and required pacemakers.

Researchers concluded that in patients with new persistent LBBB after TAVR but no advanced conduction heart blocks, an EPS demonstrating a normal HV interval or an HV interval <100ms after procainamide infusion could help rule out the need for a pacemaker for the next 30 days as confirmed by 30-day ambulatory monitoring.

Source: jacc.org/doi/10.1016/S0735-1097%2823%2900458-8