TY - JOUR
T1 - Risk Stratification in Left Bundle Branch Block After Transcatheter Aortic Valve Implantation
T2 - A Multicenter ECG Algorithm Study
AU - Badertscher, Patrick
AU - Serban, Teodor
AU - Massoullie, Gregoire
AU - Eschalier, Romain
AU - Rivard, Lena
AU - Portelance, Delphine
AU - Waksman, Ron
AU - Pavlicek, Valerie
AU - Pascale, Patrizio
AU - Pagnoni, Mattia
AU - Lambert, Thomas
AU - Reiter, Christian
AU - Steinwender, Clemens
AU - Knecht, Sven
AU - Mahfoud, Felix
AU - Sticherling, Christian
AU - Kühne, Michael
N1 - Copyright © 2025 The Authors. Published by Elsevier Inc. All rights reserved.
PY - 2025/10/24
Y1 - 2025/10/24
N2 - BACKGROUND: Managing left bundle branch block (LBBB) after transcatheter aortic valve implantation (TAVI) remains challenging.OBJECTIVES: The aim of this study was to develop a novel, simplified electrocardiogram (ECG) algorithm for predicting infranodal conduction delay in LBBB (both new onset as well as preexisting) patients after TAVI and to compare its performance vs current European Society of Cardiology (ESC) ECG criteria.METHODS: A multicenter analysis of prospectively enrolled patients undergoing electrophysiology testing for preexisting or new-onset LBBB after TAVI was conducted. The novel algorithm was developed by analyzing various combinations of the PR interval, QRS duration pre-TAVI and post-TAVI, and changes in these parameters to identify patients with infranodal conduction delay (defined as a His-ventricular interval ≥70 milliseconds).RESULTS: A total of 769 patients with LBBB (12% preexisting) after TAVI underwent risk stratification using electrophysiology testing at 7 institutions (mean age 81 ± 7 years; 57% female; 21% His-ventricular ≥70 milliseconds). A novel algorithm using solely a PR interval of 190 milliseconds and a QRS interval of 160 milliseconds revealed a sensitivity of 88% and an negative predictive value of 92% for the rule-out of infranodal conduction delay (PR interval post-TAVI <190 milliseconds AND QRS duration post-TAVI <160 milliseconds) and a specificity and positive predictive value of 85% and 41%, respectively, for the rule-in of infranodal conduction delay (PR interval post-TAVI ≥190 milliseconds AND QRS duration post-TAVI ≥160 milliseconds). By comparison, the ESC ECG criteria showed a sensitivity of 72%, a negative predictive value of 88%, specificity of 53%, and a positive predictive value of 28%.CONCLUSIONS: The novel, simplified ECG algorithm showed a superior performance for the rule-out and rule-in of infranodal conduction delay compared with current ESC ECG criteria.
AB - BACKGROUND: Managing left bundle branch block (LBBB) after transcatheter aortic valve implantation (TAVI) remains challenging.OBJECTIVES: The aim of this study was to develop a novel, simplified electrocardiogram (ECG) algorithm for predicting infranodal conduction delay in LBBB (both new onset as well as preexisting) patients after TAVI and to compare its performance vs current European Society of Cardiology (ESC) ECG criteria.METHODS: A multicenter analysis of prospectively enrolled patients undergoing electrophysiology testing for preexisting or new-onset LBBB after TAVI was conducted. The novel algorithm was developed by analyzing various combinations of the PR interval, QRS duration pre-TAVI and post-TAVI, and changes in these parameters to identify patients with infranodal conduction delay (defined as a His-ventricular interval ≥70 milliseconds).RESULTS: A total of 769 patients with LBBB (12% preexisting) after TAVI underwent risk stratification using electrophysiology testing at 7 institutions (mean age 81 ± 7 years; 57% female; 21% His-ventricular ≥70 milliseconds). A novel algorithm using solely a PR interval of 190 milliseconds and a QRS interval of 160 milliseconds revealed a sensitivity of 88% and an negative predictive value of 92% for the rule-out of infranodal conduction delay (PR interval post-TAVI <190 milliseconds AND QRS duration post-TAVI <160 milliseconds) and a specificity and positive predictive value of 85% and 41%, respectively, for the rule-in of infranodal conduction delay (PR interval post-TAVI ≥190 milliseconds AND QRS duration post-TAVI ≥160 milliseconds). By comparison, the ESC ECG criteria showed a sensitivity of 72%, a negative predictive value of 88%, specificity of 53%, and a positive predictive value of 28%.CONCLUSIONS: The novel, simplified ECG algorithm showed a superior performance for the rule-out and rule-in of infranodal conduction delay compared with current ESC ECG criteria.
UR - https://www.scopus.com/pages/publications/105026281537
U2 - 10.1016/j.jacep.2025.09.010
DO - 10.1016/j.jacep.2025.09.010
M3 - Article
C2 - 41134241
SN - 2405-5018
JO - JACC: Clinical Electrophysiology
JF - JACC: Clinical Electrophysiology
ER -