Non-invasive predictors for infranodal conduction delay in patients with left bundle branch block after TAVR,Clinical Research in Cardiology

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Non-invasive predictors for infranodal conduction delay in patients with left bundle branch block after TAVR
Clinical Research in Cardiology ( IF 5 ) Pub Date : 2021-08-26 , DOI: 10.1007/s00392-021-01924-w
Chloé Auberson ₁ , Patrick Badertscher ₁ , Antonio Madaffari ₁ , Meriton Malushi ₁ , Luc Bourquin ₁ , Florian Spies ₁ , Stefanie Aeschbacher ₁ , Gregor Fahrni ₁ , Christoph Kaiser ₁ , Raban Jeger ₁ , Stefan Osswald ₁ , Christian Sticherling ₁ , Sven Knecht ₁ , Michael Kühne ₁

Affiliation

Aims

Left bundle branch block (LBBB) is the most common conduction disorder after transcatheter aortic valve replacement (TAVR) with an increased risk of atrioventricular (AV) block. The aim of the current study was to identify non-invasive predictors for infranodal conduction delay in patients with LBBB.

Methods

We analyzed consecutive patients undergoing TAVR with pre-existing or new-onset LBBB between August 2014 and August 2020. His ventricular (HV) interval measurement was performed on day 1 after TAVR. Baseline, procedural, as well as surface and intracardiac electrocardiographic parameters were included. Infranodal conduction delay was defined as HV interval > 55 ms.

Results

Of 825 patients screened after TAVR, 151 patients (82 ± 6 years, 39% male) with LBBB were included. Among these, infranodal conduction delay was observed in 25%. ΔPR (difference in PR interval after and before TAVR), PR and QRS duration after TAVR were significantly longer in the group with HV prolongation. In a multivariate analysis in patients with sinus rhythm (n = 123), ΔPR (OR per 10 ms increase: 1.52; 95%CI: 1.19–2.01; p = 0.002) was the only independent factor associated with infranodal conduction delay. A change in PR interval by 20 ms yielded a specificity of 83% and a sensitivity of 46%, with a negative predictive value of 84% and a positive predictive value of 45% to predict HV prolongation.

Conclusions

Simple analysis of surface ECG and a calculated ΔPR < 20 ms can be used as predictor for the absence of infranodal conduction delay in post-TAVR patients with LBBB.

Graphical abstract

中文翻译：

TAVR 后左束支传导阻滞患者结下传导延迟的无创预测因子

目标

左束支传导阻滞 (LBBB) 是经导管主动脉瓣置换术 (TAVR) 后最常见的传导障碍，会增加房室 (AV) 传导阻滞的风险。本研究的目的是确定 LBBB 患者结下传导延迟的非侵入性预测因子。

方法

我们分析了 2014 年 8 月至 2020 年 8 月期间接受 TAVR 且已有或新发 LBBB 的连续患者。在 TAVR 后第 1 天进行了他的心室 (HV) 间期测量。包括基线、程序以及表面和心内心电图参数。下结节传导延迟定义为 HV 间期 > 55 ms。

结果

在 TAVR 后筛查的 825 名患者中，包括 151 名 LBBB 患者（82 ± 6 岁，39% 男性）。其中，25% 观察到结下传导延迟。在 HV 延长组中，ΔPR（TAVR 前后 PR 间期的差异）、TAVR 后 PR 和 QRS 持续时间显着延长。在对窦性心律（n = 123）患者进行的多变量分析中，ΔPR（OR 每 10 ms 增加：1.52；95%CI：1.19-2.01；p = 0.002）是与结下传导延迟相关的唯一独立因素。PR 间期改变 20 ms 产生 83% 的特异性和 46% 的敏感性，预测 HV 延长的阴性预测值为 84%，阳性预测值为 45%。