How to Cite
Betancur-Vásquez, L., Mejía-Zuluaga, M., Duarte-Suarez, N. R., Duque-Ramírez, M., & Bedoya-Jaramillo, T. M. (2020). Alternating bundle branch block: report of an unusual complication after transcatheter aortic valve implantation. Médicas UIS, 33(3), 37–42. https://doi.org/10.18273/revmed.v33n3-2020004
Abstract
onduction disorders represent a potential complication of percutaneous valve replacements. Alternating bundle branch block, although unusual, reflect extensive damage of the His-Purkinje system with potential risk of complete atrioventricular block, therefore, its identification and timely approach is important. We present the case of an 82 years old female patient with multiple comorbidities and a medical history of severe aortic stenosis in medical follow-up for a year, in whom surgical replacement had not been conducted due to the patient’s refusal and to the high surgical risk. She was admitted to the institution referring one month of progressive shortness of breath and an echocardiogram documented critical aortic stenosis. Percutaneous aortic valve implantation was performed. Due to her high risk of needing a peri or post-procedure pacemaker, Holter monitoring was performed, documenting alternating bundle branch block, which did not progress to complete atrioventricular block after 72 hours of follow-up, in consequence, a permanent pacemaker was not implanted. MÉD.UIS.2020;33(3): 37-42.
References
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11. Fazzini PF, Marchi F, Pucci P. Prognostic significance of the intraventricular blocks during acute myocardial infarction. G Ital Cardiol.
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12. Beck OA, Hochrein H. Alternating and intermittent bilateral bundle-branch block in acute myocardial infarct with development of total
trioventricular block. Z Kardiol. 1976 Mar;65(3):245–55.
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lock. Int Heart J. 2005 Jul;46(4):737–44.
14. Fisch C, Zipes DP, McHenry PL. Rate dependent aberrancy. Circulation. 1973 Oct;48(4):714–24.
15. Brignole M, Auricchio A, Baron-Esquivias G, Bordachar P, Boriani G, Breithardt O-A, et al. 2013 ESC guidelines on cardiac pacing and cardiac
esynchronization therapy: the Task force on cardiac pacing and resynchronization therapy of the European Society of Cardiology (ESC).
eveloped in collaboration with the European Heart Rhythm Association (EHRA). Europace. 2013 Aug;15(8):1070–118.
16. Baumgartner H, Falk V, Bax JJ, De Bonis M, Hamm C, Holm PJ, et al. 2017 ESC / EACTS Guidelines for the management of valvular heart disease. Eur Heart J. 2017;38(36): 2739–91.
17. Siontis GCM, Praz F, Pilgrim T, Mavridis D, Verma S, Salanti G, et al. Transcatheter aortic valve implantation vs. surgical aortic valve replacement for treatment of severe aortic stenosis: A metaanalysis of randomized trials. Eur Heart J. 2016;37(47):3503- 3512.
18. Clayton B, Morgan-Hughes G, Roobottom C. Transcatheter aortic valve insertion (TAVI): a review. Br J Radiol. 2014; 87(1033): 20130595.
19. Arora A, Misenheimer JA, Ramaraj R. Transcatheter Aortic ValveReplacement: Comprehensive Review and Present Status. Tex Heart Inst J. 2017;44(1):29–38.
20. Piazza N, Nuis R-J, Tzikas A, Otten A, Onuma Y, García-García H, et al. Persistent conduction abnormalities and requirements for pacemaking six months after transcatheter aortic valve implantation. EuroIntervention. 2010 Sep;6(4):475–84.
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22. Roten L, Wenaweser P, Delacrétaz E, Hellige G, Stortecky S, Tanner H, et al. Incidence and predictors of atrioventricular conduction impairment after transcatheter aortic valve implantation. Am J Cardiol. 2010;106(10):1473–80.
23. Erkapic D, Kim WK, Weber M, Möllmann H, Berkowitsch A, Zaltsberg S, et al. Electrocardiographic and further predictors for permanent
acemaker requirement after transcatheter aortic valve implantation. Europace. 2010;12(8):1188–9
24. Ozier D, Zivkovic N, Elbaz-Greener G, Singh SM, Wijeysundera HC. Timing of Conduction Abnormalities Leading to Permanent Pacemaker Insertion After Transcatheter Aortic Valve Implantation—A Single-Centre Review. Can J Cardiol [Internet]. 2017;33(12):1660–7. Disponible en: http://dx.doi.org/10.1016/j. cjca.2017.08.012
25. Nijenhuis VJ, Van Dijk VF, Chaldoupi SM, Balt JC, Ten Berg M. Severe conduction defects requiring permanent pacemaker
implantation in patients with a new-onset left bundle branch block after transcatheter aortic valve implantation. Europace [Internet]. 2017;19(6):1015–21. Disponible en: https://academic. oup.com/europace/article-lookup/doi/10.1093/europace/euw174
26. Becker M, Blangy H, Folliguet T, Villemin T, Freysz L, Luc A, et al. Analyse rétrospective de l’incidence, des indications et des
facteurs prédictifs d’implantation de stimulateurs cardiaques définitifs après remplacement valvulaire aortique percutané. Arch Cardiovasc Dis [Internet]. 2017;110(10):508–16. Disponible en: http://dx.doi.org/10.1016/j.acvd.2017.03.004
27. Rodés-Cabau J, Ellenbogen KA, Krahn AD, Latib A, Mack M, Mittal S, et al. Management of Conduction Disturbances Associated With Transcatheter Aortic Valve Replacement: JACC Scientific Expert Panel. J Am Coll Cardiol [Internet]. 2019;74(8):1086–106. Disponible en: https://doi.org/10.1016/j.jacc.2019.07.014
28. Dolci G, Vollema EM, van der Kley F, de Weger A, Marsan NA, Delgado V, et al. One-Year Follow-Up of Conduction Abnormalities
After Transcatheter Aortic Valve Implantation With the SAPIEN 3 Valve. Am J Cardiol. 2019;124(8):1239–45.
29. Russo E, Potenza DR, Casella M, Massaro R, Russo G, Braccio M, et al. Rate and Predictors of Permanent Pacemaker Implantation
After Transcatheter Aortic Valve Implantation: Current Status. Curr Cardiol Rev. 2019;15(3):205-18.[JV1]
2. Baumgartner H, Falk V, Bax JJ, De Bonis M, Hamm C, Holm PJ, et al. 2017 ESC/EACTS Guidelines for the management of valvular
heart disease. Eur Heart J. 2017;38(36):2739–91.
3. Paredes A, Martínez A. Prótesis valvular aórtica percutánea: ¿Qué debemos saber? Rev Chil Cardiol. 2012;31(1):55–62.
4. Blier L, Sarrazin JF, Thibault B, Rivard L, Gula L, Sit PL, et al. Transcatheter versus Surgical Aortic-Valve Replacement in High-
Risk Patients. N Engl J Med. 2011;364(23): 2187–98.
5. Leon MB, Smith CR, Mack MJ, Makkar RR, Svensson LG, Kodali SK, et al. Transcatheter or surgical aortic-valve replacement in intermediate-risk patients. N Engl J Med. 2016;374(17):1609–20.
6. Thyregod HGH, Steinbrüchel DA, Ihlemann N, Nissen H, Kjeldsen BJ, Petursson P, et al. Transcatheter versus surgical aortic valve replacement in patients with severe aortic valve stenosis: 1-year results from the all-comers NOTION randomized clinical trial. J Am Coll Cardiol. 2015;65(20):2184–94.
7. Cribier A, Eltchaninoff H, Bash A, Borenstein N, Tron C, Bauer F, et al. Percutaneous transcatheter implantation of an aortic valve prosthesis for calcific aortic stenosis: First human case description. Circulation. 2002;106(24):3006–8.
8. Durko AP, Osnabrugge RL, Van Mieghem NM, Milojevic M, Mylotte D, Nkomo VT, et al. Annual number of candidates for transcatheter aortic
alve implantation per country: current estimates and future projections. Eur Heart J. 2018;39(28):2635– 42.
9. Leon MB, Webb JG, Kodali S, Tuzcu ME, Kapadia S, Masson JB, et al. Transcatheter Aortic Valve Implantation: Review of the Nature, Management, and Avoidance of Procedural Complications. JCIN [Internet]. 2009;2(9):811–20. Disponible en: http://dx.doi. org/10.1016/j.jcin.2009.07.005
10. Karyofillis P, Kostopoulou A, Thomopoulou S, Habibi M, Livanis E, Karavolias G, et al. Conduction abnormalities after transcatheter aortic alve
mplantation. J Geriatr Cardiol. 2018;15(1):105–12.
11. Fazzini PF, Marchi F, Pucci P. Prognostic significance of the intraventricular blocks during acute myocardial infarction. G Ital Cardiol.
975;5(4):526–35.
12. Beck OA, Hochrein H. Alternating and intermittent bilateral bundle-branch block in acute myocardial infarct with development of total
trioventricular block. Z Kardiol. 1976 Mar;65(3):245–55.
13. Ogura Y, Kato J, Ogawa Y, Shiokoshi T, Kitaoka T, Suzuki T, et al. A case of alternating bundle branch block in combination with intra-Hisian
lock. Int Heart J. 2005 Jul;46(4):737–44.
14. Fisch C, Zipes DP, McHenry PL. Rate dependent aberrancy. Circulation. 1973 Oct;48(4):714–24.
15. Brignole M, Auricchio A, Baron-Esquivias G, Bordachar P, Boriani G, Breithardt O-A, et al. 2013 ESC guidelines on cardiac pacing and cardiac
esynchronization therapy: the Task force on cardiac pacing and resynchronization therapy of the European Society of Cardiology (ESC).
eveloped in collaboration with the European Heart Rhythm Association (EHRA). Europace. 2013 Aug;15(8):1070–118.
16. Baumgartner H, Falk V, Bax JJ, De Bonis M, Hamm C, Holm PJ, et al. 2017 ESC / EACTS Guidelines for the management of valvular heart disease. Eur Heart J. 2017;38(36): 2739–91.
17. Siontis GCM, Praz F, Pilgrim T, Mavridis D, Verma S, Salanti G, et al. Transcatheter aortic valve implantation vs. surgical aortic valve replacement for treatment of severe aortic stenosis: A metaanalysis of randomized trials. Eur Heart J. 2016;37(47):3503- 3512.
18. Clayton B, Morgan-Hughes G, Roobottom C. Transcatheter aortic valve insertion (TAVI): a review. Br J Radiol. 2014; 87(1033): 20130595.
19. Arora A, Misenheimer JA, Ramaraj R. Transcatheter Aortic ValveReplacement: Comprehensive Review and Present Status. Tex Heart Inst J. 2017;44(1):29–38.
20. Piazza N, Nuis R-J, Tzikas A, Otten A, Onuma Y, García-García H, et al. Persistent conduction abnormalities and requirements for pacemaking six months after transcatheter aortic valve implantation. EuroIntervention. 2010 Sep;6(4):475–84.
21. Baan JJ, Yong ZY, Koch KT, Henriques JPS, Bouma BJ, Vis MM, et al. Factors associated with cardiac conduction disorders and permanent pacemaker implantation after percutaneous aortic valve implantation with the CoreValve prosthesis. Am Heart J. 2010;159(3):497–503.
22. Roten L, Wenaweser P, Delacrétaz E, Hellige G, Stortecky S, Tanner H, et al. Incidence and predictors of atrioventricular conduction impairment after transcatheter aortic valve implantation. Am J Cardiol. 2010;106(10):1473–80.
23. Erkapic D, Kim WK, Weber M, Möllmann H, Berkowitsch A, Zaltsberg S, et al. Electrocardiographic and further predictors for permanent
acemaker requirement after transcatheter aortic valve implantation. Europace. 2010;12(8):1188–9
24. Ozier D, Zivkovic N, Elbaz-Greener G, Singh SM, Wijeysundera HC. Timing of Conduction Abnormalities Leading to Permanent Pacemaker Insertion After Transcatheter Aortic Valve Implantation—A Single-Centre Review. Can J Cardiol [Internet]. 2017;33(12):1660–7. Disponible en: http://dx.doi.org/10.1016/j. cjca.2017.08.012
25. Nijenhuis VJ, Van Dijk VF, Chaldoupi SM, Balt JC, Ten Berg M. Severe conduction defects requiring permanent pacemaker
implantation in patients with a new-onset left bundle branch block after transcatheter aortic valve implantation. Europace [Internet]. 2017;19(6):1015–21. Disponible en: https://academic. oup.com/europace/article-lookup/doi/10.1093/europace/euw174
26. Becker M, Blangy H, Folliguet T, Villemin T, Freysz L, Luc A, et al. Analyse rétrospective de l’incidence, des indications et des
facteurs prédictifs d’implantation de stimulateurs cardiaques définitifs après remplacement valvulaire aortique percutané. Arch Cardiovasc Dis [Internet]. 2017;110(10):508–16. Disponible en: http://dx.doi.org/10.1016/j.acvd.2017.03.004
27. Rodés-Cabau J, Ellenbogen KA, Krahn AD, Latib A, Mack M, Mittal S, et al. Management of Conduction Disturbances Associated With Transcatheter Aortic Valve Replacement: JACC Scientific Expert Panel. J Am Coll Cardiol [Internet]. 2019;74(8):1086–106. Disponible en: https://doi.org/10.1016/j.jacc.2019.07.014
28. Dolci G, Vollema EM, van der Kley F, de Weger A, Marsan NA, Delgado V, et al. One-Year Follow-Up of Conduction Abnormalities
After Transcatheter Aortic Valve Implantation With the SAPIEN 3 Valve. Am J Cardiol. 2019;124(8):1239–45.
29. Russo E, Potenza DR, Casella M, Massaro R, Russo G, Braccio M, et al. Rate and Predictors of Permanent Pacemaker Implantation
After Transcatheter Aortic Valve Implantation: Current Status. Curr Cardiol Rev. 2019;15(3):205-18.[JV1]
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