Late Arrhythmic Burden in Patients With Left Bundle Branch Block After TAVR With the Evolut Valve.

Abstract

Background: Arrhythmic burden after discharge in patients with new-onset persistent left bundle branch block (NOP-LBBB) following transcatheter aortic valve replacement (TAVR) with Evolut devices remains largely unknown.

Objectives: Assessing incidence and type of arrhythmias at 2-year follow-up in patients with NOP-LBBB post-TAVR.

Methods: Prospective multicentre study including 88 patients with LBBB persisting for ≥3 days post-implantation. Before discharge, an implantable loop recorder (REVEAL XT/LINQ) was implanted; patients had continuous monitoring for 2 years. Arrhythmic events were adjudicated in a central core lab.

Results: 411 arrhythmic events were detected in 58 patients (65.9%; 2 [1-4] events per patient). Symptoms were reported in 12/58 (20.7%), and therapy was changed in 25/58 (43.1%). There were 101 bradyarrhythmic events in 33 patients (35 high grade atrioventricular block [HAVB], 66 severe bradycardia). HAVB incidence was higher in the early (4-week) phase and remained stable over time, whereas severe bradycardia increased after one year. Permanent pacemaker was required in 11 (12.5%) patients (6.8% and 5.7% in the first and second year, respectively). There were 310 tachyarrythmic events in 29 patients (120 AF/AFL, 111 AT, 72 SVT, 6 NSVT, 1 VT); its incidence decreased throughout the 2 years. New AF/AFL episodes occurred in 20/69 patients (29%; symptomatic in 2/20 [10%]).

Conclusion: Patients with NOP-LBBB post-TAVR with Evolut devices exhibited a high burden of late arrhythmias, with events occurring in two thirds of patients, and leading to treatment changes in about half of them. These data should inform future studies on cardiac monitoring devices for follow-up and treatment optimization in this challenging population.