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

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

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.

Publication types

  • Multicenter Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Bundle-Branch Block / etiology*
  • Bundle-Branch Block / mortality
  • Bundle-Branch Block / physiopathology
  • Bundle-Branch Block / therapy
  • Cardiac Pacing, Artificial
  • Cause of Death
  • Disease Progression
  • Female
  • Heart Failure / etiology
  • Heart Failure / physiopathology
  • Heart Failure / therapy
  • Humans
  • Male
  • Patient Readmission
  • Retrospective Studies
  • Risk Assessment
  • Risk Factors
  • Spain
  • Stroke Volume
  • Time Factors
  • Transcatheter Aortic Valve Replacement / adverse effects*
  • Transcatheter Aortic Valve Replacement / mortality
  • Treatment Outcome
  • Ventricular Function, Left