Rodés-Cabau, JosepUrena, MarinaNombela-Franco, LuisAmat-Santos, IgnacioKleiman, NealMunoz-Garcia, AntonioAtienza, FelipeSerra, VicençDeyell, Marc WVeiga-Fernandez, GabrielaMasson, Jean-BernardCanadas-Godoy, VictoriaHimbert, DominiqueCastrodeza, JavierElizaga, JaimeFrancisco Pascual, JaumeWebb, John Gde la Torre, Jose MariaAsmarats, LluisPelletier-Beaumont, EmiliePhilippon, François2023-01-252023-01-252018-07-18http://hdl.handle.net/10668/12736The authors sought to determine: 1) the global arrhythmic burden; 2) the rate of arrhythmias leading to a treatment change; and 3) the incidence of high-degree atrioventricular block (HAVB) at 12-month follow-up in patients with new-onset persistent left bundle branch block (LBBB) following transcatheter aortic valve replacement (TAVR). Controversial data exist on the occurrence of significant arrhythmias in patients with LBBB post-TAVR. This was a multicenter prospective study including 103 consecutive patients with new-onset persistent LBBB post-TAVR with the balloon-expandable SAPIEN XT/3 valve (n = 53), or the self-expanding CoreValve/Evolut R system (n = 50). An implantable cardiac monitor (Reveal XT, Reveal Linq) was implanted at 4 (3 to 6) days post-TAVR, and patients had continuous electrocardiogram monitoring for 12 months. All arrhythmic events were adjudicated in a central electrocardiography core lab. Primary endpoints were the incidence of arrhythmias leading to a treatment change, and the incidence of HAVB at 12-month follow-up. A total of 1,553 new arrhythmic events were detected in 44 patients (1,443 episodes of tachyarrhythmia in 26 patients [atrial fibrillation/flutter/atrial tachycardia: 1,427, ventricular tachycardia 16]; 110 episodes of bradyarrhythmia in 21 patients [HAVB 54, severe bradycardia 56]). All arrhythmic events were silent in 34 patients (77%), the arrhythmic event led to a treatment change in 19 patients (18%), and 11 patients (11%) required pacemaker or implantable cardioverter-defibrillator implantation (due to HAVB, severe bradycardia, or ventricular tachycardia episodes in 9, 1, and 1 patient, respectively). A total of 12 patients died at 1-year follow-up, 1 from sudden death. A high incidence of arrhythmic events was observed at 1-year follow-up in close to one-half of the patients with LBBB post-TAVR. Significant bradyarrhythmias occurred in one-fifth of the patients, and PPM was required in nearly one-half of them. These data support the use of a cardiac monitoring device for close follow-up and expediting the initiation of treatment in this challenging group of patients. (Ambulatory Electrocardiographic Monitoring for the Detection of High-Degree Atrio-Ventricular Block in Patients With New-onset PeRsistent LEft Bundle Branch Block After Transcatheter Aortic Valve Implantation [MARE study]: NCT02153307).enatrial fibrillationbradyarrhythmiasleft bundle branch blockpacemaker implantationtranscatheter aortic valve replacementAction PotentialsAgedAged, 80 and overAortic Valve StenosisArrhythmias, CardiacBundle-Branch BlockCanadaElectrocardiography, AmbulatoryEuropeFemaleHeart RateHumansIncidenceMalePredictive Value of TestsProspective StudiesRisk FactorsTime FactorsTranscatheter Aortic Valve ReplacementTreatment OutcomeUnited Statesresearch article30031719open access10.1016/j.jcin.2018.04.0161876-7605https://doi.org/10.1016/j.jcin.2018.04.016