Electrical remodelling in patients with iatrogenic left bundle branch block

Elien B. Engels, Thomas T. Poels, Patrick Houthuizen, Peter P. T. de Jaegere, Jos G. Maessen, Kevin Vernooy, Frits W. Prinzen*

*Corresponding author for this work

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Aims Left bundle branch block (LBBB) is induced in approximately one-third of all transcatheter aortic valve implantation (TAVI) procedures. We investigated electrophysiological remodelling in patients with TAVI-induced LBBB.

Methods and results This retrospective study comprises 107 patients with initially narrow QRS complex of whom 40 did not and 67 did develop persistent LBBB after TAVI. 12-lead electrocardiograms (ECGs) taken before TAVI, within 24 hours ('acute'), and 1-12 months after TAVI ('chronic') were used to reconstruct vectorcardiograms. From these vectorcardiograms, QRS and T-wave area were calculated as comprehensive indices of depolarization and repolarization abnormalities, respectively. TAVI-induced LBBB resulted in significant acute depolarization and repolarization changes while further repolarization changes were observed with longer lasting LBBB. The amount of long-term repolarization changes (remodelling) was highly variable between patients. The change in T-wave area between acute and chronic LBBB ranged from +57% to - 77%. After dividing the LBBB cohort into tertiles based on the change in T-wave area, only baseline QRS area was larger in the tertile with no significant change in T-wave area. During longer lasting LBBB, the spatial vector gradient (SVG) changed orientation towards the direction of the QRS-vector, indicating that later-activated regions developed shorter action potential duration.

Conclusion This study in patients with TAVI-induced LBBB shows that repolarization changes develop within months after onset of LBBB, and that these changes are highly variable between individual patients.

Original languageEnglish
Pages (from-to)44-52
Number of pages9
JournalEuropace
Volume18
Issue numberSupplement 4
DOIs
Publication statusPublished - Dec 2016
Externally publishedYes
Event8th TRM Forum on Computer Simulation and Experimental Assessment of Cardiac Function - Towards Integration of Cardiac Functions - Lugano, Switzerland
Duration: 6 Dec 20158 Dec 2015

Keywords

  • Left bundle branch block
  • Transcatheter aortic valve implantation
  • Vectorcardiography
  • Electrical remodelling

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