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Multicenter Study
. 2019 Jun 24;12(12):1175-1184.
doi: 10.1016/j.jcin.2019.03.025. Epub 2019 May 22.

Long-Term Outcomes in Patients With New-Onset Persistent Left Bundle Branch Block Following TAVR

Chekrallah Chamandi  1 , Marco Barbanti  2 , Antonio Munoz-Garcia  3 , Azeem Latib  4 , Luis Nombela-Franco  5 , Enrique Gutiérrez-Ibanez  6 , Gabriela Veiga-Fernandez  7 , Asim N Cheema  8 , Ignacio Cruz-Gonzalez  9 , Vicenç Serra  10 , Corrado Tamburino  2 , Antonio Mangieri  4 , Antonio Colombo  11 , Pilar Jiménez-Quevedo  5 , Jaime Elizaga  6 , Dae-Hyun Lee  7 , Bruno Garcia Del Blanco  8 , Rishi Puri  1 , Mélanie Côté  1 , François Philippon  1 , Josep Rodés-Cabau  12
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Free article
Multicenter Study

Long-Term Outcomes in Patients With New-Onset Persistent Left Bundle Branch Block Following TAVR

Chekrallah Chamandi et al. JACC Cardiovasc Interv. .
Free article

Abstract

Objectives: The aim of this study was to determine the impact of new-onset persistent (NOP) left bundle branch block (LBBB) on long-term (>2 year) outcomes after transcatheter aortic valve replacement (TAVR).

Background: The impact of NOP-LBBB after TAVR remains controversial and no data exist regarding long-term outcomes.

Methods: A total of 1,020 consecutive patients without pre-existing LBBB or permanent pacemaker implantation (PPI) undergoing TAVR were included. NOP-LBBB was defined as any new LBBB post-TAVR that persisted at hospital discharge. Follow-up clinical and echocardiographic data were obtained at a median of 3 years (interquartile range: 2 to 5 years) post-TAVR.

Results: NOP-LBBB occurred in 212 patients (20.1%) following TAVR. There were no differences between NOP-LBBB and no NOP-LBBB groups, except for a higher use of the self-expandable CoreValve system in the NOP-LBBB group (p < 0.001). At follow-up, there were no differences between NOP-LBBB and no NOP-LBBB groups in all-cause mortality (45.3% vs. 42.5%; adjusted hazard ratio [HR]:1.09; 95% confidence interval [CI]: 0.82 to 1.47; p = 0.54), cardiovascular mortality (14.2% vs. 14.4%; adjusted HR: 1.02; 95% CI: 0.56 to 1.87; p = 0.95), or heart failure rehospitalization (19.8% vs. 15.6%; adjusted HR: 1.44; 95% CI: 0.85 to 2.46; p = 0.18). NOP-LBBB was associated with an increased risk of permanent pacemaker implantation at follow-up (15.5% vs. 5.4%; adjusted HR: 2.45; 95% CI: 1.37 to 4.38; p = 0.002), with the highest risk within the first 12 months. Left ventricular ejection fraction increased over time in patients with no NOP-LBBB but slightly decreased in those with NOP-BBB (p < 0.001 for changes in left ventricular ejection fraction between groups).

Conclusions: After a median follow-up of 3 years post-TAVR, NOP-LBBB was not associated with a higher mortality or heart failure rehospitalization. However, NOP-LBBB increased the risk of permanent pacemaker implantation and negatively impacted left ventricular function over time. These results should inform future efforts for improving the management of patients with NOP-LBBB post-TAVR.

Keywords: left bundle branch block; left ventricular ejection fraction; long-term outcomes; pacemaker; transcatheter aortic valve replacement.

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