Aortic valve implantation-induced conduction block as a framework towards a uniform electrocardiographic definition of left bundle branch block

Introduction New-onset left bundle branch block (LBBB) following transcatheter or surgical aortic valve replacement (LBBB AVI ) implies a proximal pathogenesis of LBBB. This study compares electrocardiographic characteristics and concordance with LBBB definitions between LBBB AVI and non-procedure-i...

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Published in:Netherlands heart journal 2021-12, Vol.29 (12), p.643-653
Main Authors: Calle, S., Coeman, M., Demolder, A., Philipsen, T., Kayaert, P., De Buyzere, M., Timmermans, F., De Pooter, J.
Format: Article
Language:English
Subjects:
Acute coronary syndromes
Age
Body mass index
Cardiology
Cardiovascular disease
Coronary vessels
Electrocardiography
Males
Medical Education
Medicine
Medicine & Public Health
Original
Original Article
Regression analysis
Vein & artery diseases
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Summary:Introduction New-onset left bundle branch block (LBBB) following transcatheter or surgical aortic valve replacement (LBBB AVI ) implies a proximal pathogenesis of LBBB. This study compares electrocardiographic characteristics and concordance with LBBB definitions between LBBB AVI and non-procedure-induced LBBB controls (LBBB control ). Methods All LBBB AVI patients at Ghent University Hospital between 2013 and 2019 were enrolled in the study. LBBB AVI patients were matched for age, sex, ischaemic heart disease and ejection fraction to LBBB control patients in a 1:2 ratio. For inclusion, a non-strict LBBB definition was used (QRS duration ≥ 120 ms, QS or rS in V1, absence of Q waves in V5-6). Electrocardiograms were digitally analysed and classified according to three LBBB definitions: European Society of Cardiology (ESC), Strauss and American Heart Association (AHA). Results A total of 177 patients (59 LBBB AVI and 118 LBBB control ) were enrolled in the study. LBBB AVI patients had more lateral QRS notching/slurring (100% vs 85%, p  = 0.001), included a higher percentage with a QRS duration ≥ 130 ms (98% vs 86%, p  = 0.007) and had a less leftward oriented QRS axis (−15° vs −30°, p  = 0.013) compared to the LBBB control group. ESC and Strauss criteria were fulfilled in 100% and 95% of LBBB AVI patients, respectively, but only 18% met the AHA criteria. In LBBB control patients, concordance with LBBB definitions was lower than in the LBBB AVI group: ESC 85% ( p  = 0.001), Strauss 68% ( p  
ISSN:1568-5888
1876-6250
DOI:10.1007/s12471-021-01565-8