Incidence of strict versus nonstrict left bundle branch block after transcatheter aortic valve replacement
Background Up to one-third of patients diagnosed with left bundle branch block (LBBB) by conventional electrocardiographic (ECG) criteria are misdiagnosed. Strict LBBB shows decreased left ventricular pumping efficiency compared with nonstrict LBBB. However, no previous study has evaluated the frequ...
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creator | Sundh, Frida Simlund, Jacob Harrison, John Kevin, MD Hughes, G. Chad, MD Vavalle, John, MD Maynard, Charles, PhD Strauss, David G., MD, PhD Wagner, Galen S., MD Ugander, Martin, MD, PhD |
description | Background Up to one-third of patients diagnosed with left bundle branch block (LBBB) by conventional electrocardiographic (ECG) criteria are misdiagnosed. Strict LBBB shows decreased left ventricular pumping efficiency compared with nonstrict LBBB. However, no previous study has evaluated the frequency of strict LBBB after transcatheter aortic valve replacement (TAVR). The aim of this study was to determine the incidence of developing strict versus nonstrict LBBB after TAVR and test the hypothesis that preprocedure QRS duration does not predict strict LBBB but predicts development of nonstrict LBBB. Methods All patients receiving TAVR between 4/2011 and 2/2013 (n = 71) with no preexisting bundle branch block or permanent pacemaker were included. Twelve-lead ECGs were acquired preprocedure and both 1-day and 1-month postprocedure. All ECGs were classified as strict LBBB, nonstrict LBBB, or no LBBB. Results Sixty-eight patients had ECGs eligible for final analysis. On postprocedure day 1, 25 (37%) of 68 patients developed strict LBBB, and 2 patients (3%) developed nonstrict LBBB. At 1-month follow-up, the 2 patients diagnosed with nonstrict LBBB had resolved to normal, and 5 (20%) of 25 patients with strict LBBB had resolved to normal. Preprocedure QRS duration did not predict strict LBBB ( P = .51). Because of the low incidence of nonstrict LBBB, QRS duration as a predictor of nonstrict LBBB could not be tested. Conclusions Almost all patients who developed evidence of LBBB after TAVR met the new strict criteria, indicating probable procedural injury to the left bundle branch. Preprocedural QRS duration did not predict the development of strict LBBB. |
doi_str_mv | 10.1016/j.ahj.2014.12.011 |
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Chad, MD ; Vavalle, John, MD ; Maynard, Charles, PhD ; Strauss, David G., MD, PhD ; Wagner, Galen S., MD ; Ugander, Martin, MD, PhD</creator><creatorcontrib>Sundh, Frida ; Simlund, Jacob ; Harrison, John Kevin, MD ; Hughes, G. Chad, MD ; Vavalle, John, MD ; Maynard, Charles, PhD ; Strauss, David G., MD, PhD ; Wagner, Galen S., MD ; Ugander, Martin, MD, PhD</creatorcontrib><description>Background Up to one-third of patients diagnosed with left bundle branch block (LBBB) by conventional electrocardiographic (ECG) criteria are misdiagnosed. Strict LBBB shows decreased left ventricular pumping efficiency compared with nonstrict LBBB. However, no previous study has evaluated the frequency of strict LBBB after transcatheter aortic valve replacement (TAVR). The aim of this study was to determine the incidence of developing strict versus nonstrict LBBB after TAVR and test the hypothesis that preprocedure QRS duration does not predict strict LBBB but predicts development of nonstrict LBBB. Methods All patients receiving TAVR between 4/2011 and 2/2013 (n = 71) with no preexisting bundle branch block or permanent pacemaker were included. Twelve-lead ECGs were acquired preprocedure and both 1-day and 1-month postprocedure. All ECGs were classified as strict LBBB, nonstrict LBBB, or no LBBB. Results Sixty-eight patients had ECGs eligible for final analysis. On postprocedure day 1, 25 (37%) of 68 patients developed strict LBBB, and 2 patients (3%) developed nonstrict LBBB. At 1-month follow-up, the 2 patients diagnosed with nonstrict LBBB had resolved to normal, and 5 (20%) of 25 patients with strict LBBB had resolved to normal. Preprocedure QRS duration did not predict strict LBBB ( P = .51). Because of the low incidence of nonstrict LBBB, QRS duration as a predictor of nonstrict LBBB could not be tested. Conclusions Almost all patients who developed evidence of LBBB after TAVR met the new strict criteria, indicating probable procedural injury to the left bundle branch. Preprocedural QRS duration did not predict the development of strict LBBB.</description><identifier>ISSN: 0002-8703</identifier><identifier>ISSN: 1097-6744</identifier><identifier>EISSN: 1097-6744</identifier><identifier>DOI: 10.1016/j.ahj.2014.12.011</identifier><identifier>PMID: 25728735</identifier><identifier>CODEN: AHJOA2</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Aged ; Aged, 80 and over ; Aortic Valve Stenosis - surgery ; Bundle-Branch Block - diagnosis ; Bundle-Branch Block - epidemiology ; Cardiac arrhythmia ; Cardiovascular ; Drug therapy ; Electrocardiography ; Female ; Heart attacks ; Humans ; Incidence ; Male ; Medicin och hälsovetenskap ; Postoperative Complications - epidemiology ; Predictive Value of Tests ; Retrospective Studies ; Transcatheter Aortic Valve Replacement</subject><ispartof>The American heart journal, 2015-03, Vol.169 (3), p.438-444</ispartof><rights>Elsevier Inc.</rights><rights>2015 Elsevier Inc.</rights><rights>Copyright © 2015 Elsevier Inc. All rights reserved.</rights><rights>Copyright Elsevier Limited Mar 2015</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c594t-c0fd8865d5c99f4c73f73b1b563e6ea452d53060e0d4ec1583c3c45598bcd4653</citedby><cites>FETCH-LOGICAL-c594t-c0fd8865d5c99f4c73f73b1b563e6ea452d53060e0d4ec1583c3c45598bcd4653</cites><orcidid>0000-0002-1644-7814</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.proquest.com/docview/1658763141?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>230,314,780,784,885,3550,27924,27925,45995,64385,64387,64389,72469</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25728735$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttp://kipublications.ki.se/Default.aspx?queryparsed=id:130891541$$DView record from Swedish Publication Index$$Hfree_for_read</backlink></links><search><creatorcontrib>Sundh, Frida</creatorcontrib><creatorcontrib>Simlund, Jacob</creatorcontrib><creatorcontrib>Harrison, John Kevin, MD</creatorcontrib><creatorcontrib>Hughes, G. Chad, MD</creatorcontrib><creatorcontrib>Vavalle, John, MD</creatorcontrib><creatorcontrib>Maynard, Charles, PhD</creatorcontrib><creatorcontrib>Strauss, David G., MD, PhD</creatorcontrib><creatorcontrib>Wagner, Galen S., MD</creatorcontrib><creatorcontrib>Ugander, Martin, MD, PhD</creatorcontrib><title>Incidence of strict versus nonstrict left bundle branch block after transcatheter aortic valve replacement</title><title>The American heart journal</title><addtitle>Am Heart J</addtitle><description>Background Up to one-third of patients diagnosed with left bundle branch block (LBBB) by conventional electrocardiographic (ECG) criteria are misdiagnosed. Strict LBBB shows decreased left ventricular pumping efficiency compared with nonstrict LBBB. However, no previous study has evaluated the frequency of strict LBBB after transcatheter aortic valve replacement (TAVR). The aim of this study was to determine the incidence of developing strict versus nonstrict LBBB after TAVR and test the hypothesis that preprocedure QRS duration does not predict strict LBBB but predicts development of nonstrict LBBB. Methods All patients receiving TAVR between 4/2011 and 2/2013 (n = 71) with no preexisting bundle branch block or permanent pacemaker were included. Twelve-lead ECGs were acquired preprocedure and both 1-day and 1-month postprocedure. All ECGs were classified as strict LBBB, nonstrict LBBB, or no LBBB. Results Sixty-eight patients had ECGs eligible for final analysis. On postprocedure day 1, 25 (37%) of 68 patients developed strict LBBB, and 2 patients (3%) developed nonstrict LBBB. At 1-month follow-up, the 2 patients diagnosed with nonstrict LBBB had resolved to normal, and 5 (20%) of 25 patients with strict LBBB had resolved to normal. Preprocedure QRS duration did not predict strict LBBB ( P = .51). Because of the low incidence of nonstrict LBBB, QRS duration as a predictor of nonstrict LBBB could not be tested. Conclusions Almost all patients who developed evidence of LBBB after TAVR met the new strict criteria, indicating probable procedural injury to the left bundle branch. Preprocedural QRS duration did not predict the development of strict LBBB.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Aortic Valve Stenosis - surgery</subject><subject>Bundle-Branch Block - diagnosis</subject><subject>Bundle-Branch Block - epidemiology</subject><subject>Cardiac arrhythmia</subject><subject>Cardiovascular</subject><subject>Drug therapy</subject><subject>Electrocardiography</subject><subject>Female</subject><subject>Heart attacks</subject><subject>Humans</subject><subject>Incidence</subject><subject>Male</subject><subject>Medicin och hälsovetenskap</subject><subject>Postoperative Complications - epidemiology</subject><subject>Predictive Value of Tests</subject><subject>Retrospective Studies</subject><subject>Transcatheter Aortic Valve Replacement</subject><issn>0002-8703</issn><issn>1097-6744</issn><issn>1097-6744</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNp9kl9rFDEUxQdR7Fr9AL5IwBdfZk0mf2YGQZCitlDwQX0OmZs7bGazM2uSWem3N9PdtlCoT8m9_M4huecWxVtG14wy9XFYm82wrigTa1atKWPPihWjbV2qWojnxYpSWpVNTflZ8SrGIZeqatTL4qySddXUXK6K4WoEZ3EEJFNPYgoOEjlgiHMk4zSeGh77RLp5tB5JF8wIG9L5CbbE9AkDSbkVwaQNLpWZQnJADsYfkATcewO4wzG9Ll70xkd8czrPi9_fvv66uCyvf3y_uvhyXYJsRSqB9rZplLQS2rYXUPO-5h3rpOKo0AhZWcmpokitQGCy4cBBSNk2HVihJD8vyqNv_Iv7udP74HYm3OjJOH1qbfMNtWSSC5b59kl-Hyb7ILoTMk6blslb7YejNoN_ZoxJ71wE9N6MOM1RM6WoqJjiVUbfP0KHaQ5jnkSmZFMrzm4N2ZGCMMUYsL9_DqN6CV0POoeul9A1q3QOPWvenZznbof2XnGXcgY-HQHMYz84DDqCWzK3LiAkbSf3X_vPj9Tg3ejA-C3eYHz4hY5ZoH8uW7csHROU1qKh_B_dfdNQ</recordid><startdate>20150301</startdate><enddate>20150301</enddate><creator>Sundh, Frida</creator><creator>Simlund, Jacob</creator><creator>Harrison, John Kevin, MD</creator><creator>Hughes, G. Chad, MD</creator><creator>Vavalle, John, MD</creator><creator>Maynard, Charles, PhD</creator><creator>Strauss, David G., MD, PhD</creator><creator>Wagner, Galen S., MD</creator><creator>Ugander, Martin, MD, PhD</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QO</scope><scope>7RV</scope><scope>7TS</scope><scope>7X7</scope><scope>7XB</scope><scope>88C</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AN0</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M0T</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope><scope>ADTPV</scope><scope>AOWAS</scope><orcidid>https://orcid.org/0000-0002-1644-7814</orcidid></search><sort><creationdate>20150301</creationdate><title>Incidence of strict versus nonstrict left bundle branch block after transcatheter aortic valve replacement</title><author>Sundh, Frida ; Simlund, Jacob ; Harrison, John Kevin, MD ; Hughes, G. Chad, MD ; Vavalle, John, MD ; Maynard, Charles, PhD ; Strauss, David G., MD, PhD ; Wagner, Galen S., MD ; Ugander, Martin, MD, PhD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c594t-c0fd8865d5c99f4c73f73b1b563e6ea452d53060e0d4ec1583c3c45598bcd4653</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Aortic Valve Stenosis - surgery</topic><topic>Bundle-Branch Block - diagnosis</topic><topic>Bundle-Branch Block - epidemiology</topic><topic>Cardiac arrhythmia</topic><topic>Cardiovascular</topic><topic>Drug therapy</topic><topic>Electrocardiography</topic><topic>Female</topic><topic>Heart attacks</topic><topic>Humans</topic><topic>Incidence</topic><topic>Male</topic><topic>Medicin och hälsovetenskap</topic><topic>Postoperative Complications - epidemiology</topic><topic>Predictive Value of Tests</topic><topic>Retrospective Studies</topic><topic>Transcatheter Aortic Valve Replacement</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Sundh, Frida</creatorcontrib><creatorcontrib>Simlund, Jacob</creatorcontrib><creatorcontrib>Harrison, John Kevin, MD</creatorcontrib><creatorcontrib>Hughes, G. Chad, MD</creatorcontrib><creatorcontrib>Vavalle, John, MD</creatorcontrib><creatorcontrib>Maynard, Charles, PhD</creatorcontrib><creatorcontrib>Strauss, David G., MD, PhD</creatorcontrib><creatorcontrib>Wagner, Galen S., MD</creatorcontrib><creatorcontrib>Ugander, Martin, MD, PhD</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Biotechnology Research Abstracts</collection><collection>Nursing & Allied Health Database</collection><collection>Physical Education Index</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Healthcare Administration Database (Alumni)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>British Nursing Database</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Healthcare Administration Database</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><collection>SwePub</collection><collection>SwePub Articles</collection><jtitle>The American heart journal</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Sundh, Frida</au><au>Simlund, Jacob</au><au>Harrison, John Kevin, MD</au><au>Hughes, G. Chad, MD</au><au>Vavalle, John, MD</au><au>Maynard, Charles, PhD</au><au>Strauss, David G., MD, PhD</au><au>Wagner, Galen S., MD</au><au>Ugander, Martin, MD, PhD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Incidence of strict versus nonstrict left bundle branch block after transcatheter aortic valve replacement</atitle><jtitle>The American heart journal</jtitle><addtitle>Am Heart J</addtitle><date>2015-03-01</date><risdate>2015</risdate><volume>169</volume><issue>3</issue><spage>438</spage><epage>444</epage><pages>438-444</pages><issn>0002-8703</issn><issn>1097-6744</issn><eissn>1097-6744</eissn><coden>AHJOA2</coden><abstract>Background Up to one-third of patients diagnosed with left bundle branch block (LBBB) by conventional electrocardiographic (ECG) criteria are misdiagnosed. Strict LBBB shows decreased left ventricular pumping efficiency compared with nonstrict LBBB. However, no previous study has evaluated the frequency of strict LBBB after transcatheter aortic valve replacement (TAVR). The aim of this study was to determine the incidence of developing strict versus nonstrict LBBB after TAVR and test the hypothesis that preprocedure QRS duration does not predict strict LBBB but predicts development of nonstrict LBBB. Methods All patients receiving TAVR between 4/2011 and 2/2013 (n = 71) with no preexisting bundle branch block or permanent pacemaker were included. Twelve-lead ECGs were acquired preprocedure and both 1-day and 1-month postprocedure. All ECGs were classified as strict LBBB, nonstrict LBBB, or no LBBB. Results Sixty-eight patients had ECGs eligible for final analysis. On postprocedure day 1, 25 (37%) of 68 patients developed strict LBBB, and 2 patients (3%) developed nonstrict LBBB. At 1-month follow-up, the 2 patients diagnosed with nonstrict LBBB had resolved to normal, and 5 (20%) of 25 patients with strict LBBB had resolved to normal. Preprocedure QRS duration did not predict strict LBBB ( P = .51). Because of the low incidence of nonstrict LBBB, QRS duration as a predictor of nonstrict LBBB could not be tested. Conclusions Almost all patients who developed evidence of LBBB after TAVR met the new strict criteria, indicating probable procedural injury to the left bundle branch. Preprocedural QRS duration did not predict the development of strict LBBB.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>25728735</pmid><doi>10.1016/j.ahj.2014.12.011</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0002-1644-7814</orcidid></addata></record> |
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subjects | Aged Aged, 80 and over Aortic Valve Stenosis - surgery Bundle-Branch Block - diagnosis Bundle-Branch Block - epidemiology Cardiac arrhythmia Cardiovascular Drug therapy Electrocardiography Female Heart attacks Humans Incidence Male Medicin och hälsovetenskap Postoperative Complications - epidemiology Predictive Value of Tests Retrospective Studies Transcatheter Aortic Valve Replacement |
title | Incidence of strict versus nonstrict left bundle branch block after transcatheter aortic valve replacement |
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