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Hein-Rothweiler, Ralph; Jochheim, David; Rizas, Konstantinos; Egger, Alexander; Theiss, Hans; Bauer, Axel; Massberg, Steffen; Mehilli, Julinda (2017): Aortic Annulus to Left Coronary Distance as a Predictor for Persistent Left Bundle Branch Block After TAVI. In: Catheterization and Cardiovascular interventions, Vol. 89, No. 4, E162-E168
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Abstract

Objectives: To identify potential predictors for ventricular conduction delay and to evaluate the impact of interventricular dyssynchrony on mortality after implantation of a balloon-expandable aortic valve (BEV). Methods and results: Clinical, computertomo-graphical (CT), and electrocardiographical (ECG) data from 225 transcatheter aortic valve implantation (TAVI) patients were analyzed. Procedures were performed between May 2010 and September 2013 via transfemoral access using a BEV. Incidence of new-onset left bundle branch block (NOP-LBBB) at discharge was 23.1% (n552). Predictive factors for NOP-LBBB were first degree atrioventricular (AV) block (odds ratio (OR): 3.91, 95% confidence interval (CI): 1.58 to 9.64), area cover index (OR: 1.83, 95% CI: 1.26 to 2.67), annulus calcification >first degree (OR: 3.01, 95% CI: 1.36 to 6.66), and annulus to left coronary distance (OR: 0.65, 95% CI: 0.44 to 0.96). At 1-year follow-up, no significant difference was observed concerning all-cause mortality (15.6% among non NOP-LBBB and 9.6% among NOP-LBBB patients, P = 0.278) and cardiovascular mortality (4.6% among non NOP-LBBB and 5.8% among NOP-LBBB patients, P = 0.737). Conclusion: In addition to previous predictors, annulus to left coronary distance and area cover index have been identified as new predictors for NOP-LBBB. NOP-LBBB showed no relevant impact on mortality after one year. Further investigation including larger populations and longer follow-up is required to confirm these findings and develop an algorithm for identification of patients at risk for NOP-LBBB associated adverse events. (C) 2016 Wiley Periodicals, Inc.