The QRS frontal plane axis changes during left bundle branch block after transcatheter aortic valve replacement

Oren Yagel, Bernard Belhassen, David Planer, Offer Amir, Gabby Elbaz-Greener

Research output: Contribution to journalArticlepeer-review

Abstract

Background and Aims: Left bundle branch block (LBBB) is common after transcatheter aortic valve replacement (TAVR) and associated with a left or normal QRS axis. We aim to assess the QRS frontal plane axis shift changes during LBBB after TAVR and determine if the risk of procedure-related high degree atrioventricular block (AVB) is affected by QRS axis shift changes. Methods and Results: In a retrospective single-center study of 720 consecutive patients who underwent TAVR, 141 (19.6%) with normal baseline QRS duration developed a new LBBB after TAVR and constituted the study group. Most patients (59.6%) were females and the mean age of the cohort was 81.2 ± 6 years. Results: As compared with the baseline QRS axis before TAVR, the occurrence of LBBB was associated with a leftward QRS axis shift (by 40 ± 28.3°) in 73% of the study patients and a rightward (by 18.6 ± 19.4°) or no change in QRS axis in 25.6% and 1.4% of the study patients, respectively. A left QRS axis (−30°) was observed in 14.9% and 38.3% of the study patients before and after TAVR, respectively. The group of patients exhibiting a rightward or no QRS axis shift had a greater incidence of high degree AVB than the group of patients exhibiting a leftward QRS axis shift (18.4% vs. 6.8%, p =.056). Conclusion: Although post TAVR-LBBB is associated with a leftward QRS axis shift in most patients, a non-negligible proportion of patients (27%) exhibited a rightward or no QRS axis shift. The latter group tend to have a higher risk of developing high degree AVB.

Original languageEnglish
Pages (from-to)1291-1301
Number of pages11
JournalPACE - Pacing and Clinical Electrophysiology
Volume46
Issue number11
DOIs
StatePublished - Nov 2023
Externally publishedYes

Bibliographical note

Publisher Copyright:
© 2023 Wiley Periodicals LLC.

Keywords

  • QRS frontal axis
  • atrioventricular block
  • left axis deviation
  • left bundle branch block
  • transcatheter aortic valve replacement

Fingerprint

Dive into the research topics of 'The QRS frontal plane axis changes during left bundle branch block after transcatheter aortic valve replacement'. Together they form a unique fingerprint.

Cite this