rC DR Response to Letter Regarding Article, ''Clinical Impact of Persistent Left Bundle-Branch Block After Transcatheter Aortic Valve Implantation With CoreValve Revalving System'' Francesco Bedogni, Azeem Latib, Federico De Marco, Mauro Agnifili, Jacopo Oreglia, Samuele Pizzocri, Roberto A. Latini, Stefania Lanotte, Anna Sonia Petronio, Marco De Carlo, Federica Ettori, Claudia Fiorina, Arnaldo Poli, Silvia Cirri, Stefano De Servi, Angelo Ramondo, Giuseppe Tarantini, Antonio Marzocchi, Rosario Fiorilli, Silvio Klugmann, Gian Paolo Ussia, Corrado Tamburino, Francesco Maisano, Nedy Brambilla, Antonio Colombo and Luca Testa po Circulation. 2013;128:e444 doi: 10.1161/CIRCULATIONAHA.113.005705 or iza da Circulation is published by the American Heart Association, 7272 Greenville Avenue, Dallas, TX 75231 Copyright © 2013 American Heart Association, Inc. All rights reserved. Print ISSN: 0009-7322. Online ISSN: 1524-4539 ut The online version of this article, along with updated information and services, is located on the World Wide Web at: pi aa http://circ.ahajournals.org/content/128/22/e444 An erratum has been published regarding this article. Please see the attached page for: Co http://circ.ahajournals.org/content/129/5/e327.full.pdf Permissions: Requests for permissions to reproduce figures, tables, or portions of articles originally published in Circulation can be obtained via RightsLink, a service of the Copyright Clearance Center, not the Editorial Office. Once the online version of the published article for which permission is being requested is located, click Request Permissions in the middle column of the Web page under Services. Further information about this process is available in the Permissions and Rights Question and Answer document. Reprints: Information about reprints can be found online at: http://www.lww.com/reprints Subscriptions: Information about subscribing to Circulation is online at: http://circ.ahajournals.org//subscriptions/ Downloaded from http://circ.ahajournals.org/ at Pfizer DIS on August 15, 2014 15/08/2014 Correspondence Article Type Federico De Marco, MD Niguarda Ca Granda Hospital Milan, Italy Response to Letter Regarding Article, “Clinical Impact of Persistent Left Bundle-Branch Block After Transcatheter Aortic Valve Implantation With CoreValve Revalving System” Mauro Agnifili, MD Department of Cardiology Istituto Clinico S. Ambrogio Milan, Italy Jacopo Oreglia, MD Niguarda Ca Granda Hospital Milan, Italy Samuele Pizzocri, MD Roberto A. Latini, MD Stefania Lanotte, MD Department of Cardiology Istituto Clinico S. Ambrogio Milan, Italy Federica Ettori, MD Claudia Fiorina, MD Cardiothoracic Department Spedali Civili Brescia, Italy da po rC DR Anna Sonia Petronio, MD Marco De Carlo, MD Cardiothoracic and Vascular Department Azienda Ospedaliero-Universitaria Pisana Pisa, Italy Arnaldo Poli, MD Azienda Ospedaliera Legnano Legnano, Italy iza We appreciate the interest of Prinzen et al about our article,1 but some of their comments need to be addressed. Prinzen et al analyzed a mixed population of patients treated with CoreValve or Edwards Sapien prostheses.2 Of note, their different influence on the cardiac conduction system is well known,3 with the CoreValve being more prone to determine conduction disturbances as a consequence of the larger frame. Accordingly, we decided to specifically focus on the CoreValve, pooling >800 patients, which is more than double the population considered by Prinzen et al. It is clear that the internal and external validity (ie, the extent of systematic biases and the generalizability of the results) are highly affected by the sample size. Prinzen et al excluded patients who underwent pacemaker implantation within 30 days after transcatheter aortic valve replacement, which, in our opinion, makes little sense because the left bundle-branch block (LBBB) usually develops immediately and its short-term effect was unclear. The latter was one of the aims of our study. We excluded those who were implanted urgently within 48 hours, and, among the remaining patients, those showing a new-onset LBBB had a higher risk of pacemaker implantation within the first month after transcatheter aortic valve replacement. As for these points, Prinzen et al suggest that a considerable proportion of patients with LBBB was protected against bradyarrhithmic death. The logical consequence of this hypothesis is that the very tight follow-up we implemented for those patients was very successful and should be advocated on a routine basis. As for the diagnostic issue, the citation from Prinzen et al has little to do with the transcatheter aortic valve replacement scenario, and the criteria we used are accepted worldwide. With respect to the QRS duration in patients with LBBB, we found that the widening of the QRS was remarkable, reaching a mean duration of 142 ms (range of 130–155 ms). Prinzen et al probably interpreted 130 ms as the 25th percentile; it was instead the lower limit. Thus, their doubts seem groundless. Prinzen et al probably misinterpreted also the percentage of LBBB in our study: it was 43.2% (ie, close to the 51% they reported). This percentage decreased afterward, which is consistent with data from the literature. In conclusion, logistic EuroSCORE in our study was higher: this is a consequence of the fact that only patients at a very high or prohibitive risk for surgery were included. In such a population, which is supposed to be the real transcatheter aortic valve replacement population, it is conceivable that other predictive factors play a critical role in determining the prognosis. Co pi aa ut or Silvia Cirri, MD Department of Cardiology Istituto Clinico S. Ambrogio Milan, Italy Disclosures Dr Bedogni is a medical proctor for Medtronic. Dr Ussia, Dr Petronio, and Dr Ramondo are TAVI medical proctors for Medtronic. The other authors report no conflicts. Stefano De Servi, MD Azienda Ospedaliera Legnano Legnano, Italy Angelo Ramondo, MD Ospedale di Bassano del Grappa Vicenza, Italy Giuseppe Tarantini, MD Department of Cardiac Thoracic and Vascular Sciences University of Padova Padova, Italy Antonio Marzocchi, MD Institute of Cardiology St. Orsola/Malpighi Hospital Bologna University Bologna, Italy Francesco Bedogni, MD Department of Cardiology Istituto Clinico S. Ambrogio Milan, Italy Rosario Fiorilli, MD Ospedale San Camillo Rome, Italy Azeem Latib, MD Interventional Cardiology Unit San Raffaele Hospital and EMO-GVM Centro Cuore Columbus Milan, Italy Silvio Klugmann Niguarda Ca Granda Hospital Milan, Italy (Circulation. 2013;128:e444-e445.) © 2013 American Heart Association, Inc. Circulation is available at http://circ.ahajournals.org DOI: 10.1161/CIRCULATIONAHA.113.005705 Downloaded from http://circ.ahajournals.org/ e444 at Pfizer DIS on August 15, 2014 15/08/2014 Correspondence e445 Luca Testa, MD, PhD Department of Cardiology Istituto Clinico S. Ambrogio Milan, Italy Gian Paolo Ussia, MD Corrado Tamburino, MD Ferrarotto Hospital Catania, Italy Francesco Maisano, MD Interventional Cardiology Unit San Raffaele Hospital and EMO-GVM Centro Cuore Columbus Milan, Italy References 1. Testa L, Latib A, De Marco F, De Carlo M, Agnifili M, Latini RA, Petronio AS, Ettori F, Poli A, De Servi S, Ramondo A, Napodano M, Klugmann S, Ussia GP, Tamburino C, Brambilla N, Colombo A, Bedogni F. Clinical impact of persistent left bundle-branch block after transcatheter aortic valve implantation with CoreValve Revalving System. Circulation. 2013;127:1300–1307. 2. Houthuizen P, Van Garsse LA, Poels TT, de Jaegere P, van der Boon RM, Swinkels BM, Ten Berg JM, van der Kley F, Schalij MJ, Baan J Jr, Cocchieri R, Brueren GR, van Straten AH, den Heijer P, Bentala M, van Ommen V, Kluin J, Stella PR, Prins MH, Maessen JG, Prinzen FW. Left bundle-branch block induced by transcatheter aortic valve implantation increases risk of death. Circulation. 2012;126:720–728. 3. Erkapic D, De Rosa S, Kelava A, Lehmann R, Fichtlscherer S, Hohnloser SH. Risk for permanent pacemaker after transcatheter aortic valve implantation: a comprehensive analysis of the literature. J Cardiovasc Electrophysiol. 2012;23:391–397. Nedy Brambilla, MD Department of Cardiology Istituto Clinico S. Ambrogio Milan, Italy Co pi aa ut or iza da po rC DR Antonio Colombo, MD Interventional Cardiology Unit San Raffaele Hospital and EMO-GVM Centro Cuore Columbus Milan, Italy Downloaded from http://circ.ahajournals.org/ at Pfizer DIS on August 15, 2014 15/08/2014 Correction In the article by Bedogni et al, “Response to Letter Regarding Article, ‘Clinical Impact of Persistent Left Bundle-Branch Block After Transcatheter Aortic Valve Implantation With CoreValve Revalving System’,” which was published in the November 26, 2013 issue of the journal (Circulation. 2013;128:e444), the order of authors was incorrect. The author list should have read: Stefano De Servi, MD Azienda Ospedaliera Legnano Legnano, Italy Francesco Bedogni, MD Department of Cardiology Istituto Clinico S. Ambrogio Milan, Italy Angelo Ramondo, MD Ospedale di Bassano del Grappa Vicenza, Italy Azeem Latib, MD Interventional Cardiology Unit San Raffaele Hospital and EMO-GVM Centro Cuore Columbus Milan, Italy Giuseppe Tarantini, MD Department of Cardiac Thoracic and Vascular Sciences University of Padova Padova, Italy DR Federico De Marco, MD Niguarda Ca Granda Hospital Milan, Italy rC po Mauro Agnifili, MD Department of Cardiology Istituto Clinico S. Ambrogio Milan, Italy or iza da Jacopo Oreglia, MD Niguarda Ca Granda Hospital Milan, Italy Samuele Pizzocri, MD Roberto A. Latini, MD Stefania Lanotte, MD Department of Cardiology Istituto Clinico S. Ambrogio Milan, Italy Rosario Fiorilli, MD Ospedale San Camillo Rome, Italy Silvio Klugmann Niguarda Ca Granda Hospital Milan, Italy pi aa ut Gian Paolo Ussia, MD Corrado Tamburino, MD Ferrarotto Hospital Catania, Italy Francesco Maisano, MD Interventional Cardiology Unit San Raffaele Hospital and EMO-GVM Centro Cuore Columbus Milan, Italy Co Anna Sonia Petronio, MD Marco De Carlo, MD Cardiothoracic and Vascular Department Azienda Ospedaliero-Universitaria Pisana Pisa, Italy Federica Ettori, MD Claudia Fiorina, MD Cardiothoracic Department Spedali Civili Brescia, Ital Antonio Marzocchi, MD Institute of Cardiology St. Orsola/Malpighi Hospital Bologna University Bologna, Italy Nedy Brambilla, MD Department of Cardiology Istituto Clinico S. Ambrogio Milan, Italy Arnaldo Poli, MD Azienda Ospedaliera Legnano Legnano, Italy Antonio Colombo, MD Interventional Cardiology Unit San Raffaele Hospital and EMO-GVM Centro Cuore Columbus Milan, Italy Silvia Cirri, MD Department of Cardiology Istituto Clinico S. Ambrogio Milan, Italy Luca Testa, MD, PhD Department of Cardiology Istituto Clinico S. Ambrogio Milan, Italy The current online version of the article has been corrected. (Circulation. 2014;129:e327.) © 2014 American Heart Association, Inc. Circulation is available at http://circ.ahajournals.org DOI: 10.1161/CIR.0000000000000014 e327 15/08/2014
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