Impact of new-onset persistent left bundle branch block on late clinical outcomes in patients undergoing transcatheter aortic valve implantation with a balloon-expandable valve

JACC Cardiovasc Interv. 2014 Feb;7(2):128-136. doi: 10.1016/j.jcin.2013.08.015. Epub 2014 Jan 15.

Abstract

Objectives: The aim of this study was to determine the impact of new-onset persistent left bundle branch block (NOP-LBBB) on late outcomes after transcatheter aortic valve implantation (TAVI).

Background: The impact of NOP-LBBB after TAVI remains controversial.

Methods: A total of 668 consecutive patients who underwent TAVI with a balloon-expandable valve without pre-existing LBBB or permanent pacemaker implantation (PPI) were included. Electrocardiograms were obtained at baseline, immediately after the procedure, and daily until hospital discharge. Patients were followed at 1, 6, and 12 months and yearly thereafter.

Results: New-onset LBBB occurred in 128 patients (19.2%) immediately after TAVI and persisted at hospital discharge in 79 patients (11.8%). At a median follow-up of 13 months (range 3 to 27 months), there were no differences in mortality rate between the NOP-LBBB and no NOP-LBBB groups (27.8% vs. 28.4%; adjusted-hazard ratio: 0.87 [95% confidence interval (CI): 0.55 to 1.37]; p = 0.54). There were no differences between groups regarding cardiovascular mortality (p = 0.82), sudden death (p = 0.87), rehospitalizations for all causes (p = 0.11), or heart failure (p = 0.55). NOP-LBBB was the only factor associated with an increased rate of PPI during the follow-up period (13.9% vs. 3.0%; hazard ratio: 4.29 [95% CI: 2.03 to 9.07], p < 0.001. NOP-LBBB was also associated with a lack of left ventricular ejection fraction improvement and poorer New York Heart Association functional class at follow-up (p < 0.02 for both).

Conclusions: NOP-LBBB occurred in ∼1 of 10 patients who had undergone TAVI with a balloon-expandable valve. NOP-LBBB was associated with a higher rate of PPI, a lack of improvement in left ventricular ejection fraction, and a poorer functional status, but did not increase the risk of global or cardiovascular mortality or rehospitalizations at 1-year follow-up.

Keywords: aortic stenosis; heart failure; left bundle branch block; permanent pacemaker implantation; transcatheter aortic valve implantation; transcatheter aortic valve replacement.

Publication types

  • Multicenter Study
  • Observational Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Aortic Valve Stenosis / diagnosis
  • Aortic Valve Stenosis / mortality
  • Aortic Valve Stenosis / physiopathology
  • Aortic Valve Stenosis / therapy*
  • Balloon Valvuloplasty
  • Bundle-Branch Block / diagnosis
  • Bundle-Branch Block / etiology*
  • Bundle-Branch Block / mortality
  • Bundle-Branch Block / physiopathology
  • Bundle-Branch Block / therapy
  • Canada
  • Cardiac Catheterization / adverse effects*
  • Cardiac Catheterization / instrumentation*
  • Cardiac Catheterization / mortality
  • Cardiac Pacing, Artificial
  • Female
  • Heart Failure / etiology
  • Heart Failure / physiopathology
  • Heart Valve Prosthesis Implantation / adverse effects*
  • Heart Valve Prosthesis Implantation / instrumentation*
  • Heart Valve Prosthesis Implantation / mortality
  • Heart Valve Prosthesis*
  • Hemodynamics
  • Humans
  • Male
  • Pacemaker, Artificial
  • Patient Readmission
  • Prosthesis Design
  • Risk Assessment
  • Risk Factors
  • Spain
  • Stroke Volume
  • Time Factors
  • Treatment Outcome
  • Ventricular Function, Left