A new electrocardiographic definition of left bundle branch block (LBBB) in patients after transcatheter aortic valve replacement (TAVR)

• Published in: Journal of electrocardiology 2020-11, Vol.63, p.167-172
• Main Authors: Alqarawi, Wael, Sadek, Mouhannad M., Golian, Mehrdad, Hibbert, Benjamin, Redpath, Calum J., Nair, Girish M., Nery, Pablo B., Davis, Darryl R., Klein, Andres, Birnie, David H., Green, Martin S.
• Format: Article
• Language: English
• Subjects: Cardiac arrhythmia; Cardiac resynchronization therapy; ECG; Electrocardiography; Heart attacks; Heart surgery; His bundle pacing; LBBB; Transcatheter aortic valve replacement
• ISSN: 0022-0736; 1532-8430
• DOI: 10.1016/j.jelectrocard.2019.10.005

Current LBBB definitions cannot always distinguish LBBB from left ventricular conduction delay. Only patients with LBBB are expected to normalize with His bundle pacing. Patients who develop new LBBB immediately post transcatheter aortic valve replacement (TAVR) provide an excellent model to define electrocardiogram (ECG) features of LBBB. We sought to describe their ECG features and develop a new ECG definition of LBBB. We screened ECGs from 264 consecutive patients who underwent TAVR at the University of Ottawa Heart Institute. Patients with a baseline QRS of ≤100 ms who developed QRS ≥120 ms immediately after TAVR were included. Two electrocardiologists reviewed all ECG independently. Baseline demographics and echocardiographic data were retrospectively collected. 36 patients were included in the analysis. The median age was 85.5 years (IQR, 81.8–89 years) and 52.8% were males. The minimum QRS duration was 126 ms. The median QRS axis was −18° (IQR, −40–4.5°), which is 18.5° leftward compared to the median QRS axis before TAVR. Fourteen patients (38.9%) had left axis deviation. All patients had a notched/slurred R wave in at least one lateral lead and an R wave duration of ≤20 ms in V1 when present. We developed a new ECG definition of LBBB that includes 2 novel findings: notching/slurring of the R wave in at least one lateral lead and an R wave ≤20 ms in V1. Further larger studies are warranted to confirm these findings. •All LBBB patients had a notched/slurred R wave in at least one lateral lead.•All LBBB patients had R wave duration of ≤20 ms in V1 when present.•The minimum QRS duration with LBBB was 126 ms.•LBBB development post TAVR resulted in 18.5° leftward shift in axis.•The median QRS axis with LBBB was −18° and 39% had left axis deviation.