Risk Stratification of New Persistent Left Bundle Branch Block After Transcatheter Aortic Valve Implantation

Takahiro Tsushima, Anthony Main, Sadeer G. Al-Kindi, Luis Augusto Palma Dallan, Heather L. Wheat, Cristian R. Baeza, Marc P. Pelletier, Mauricio S. Arruda, Judith A. Mackall, Sergio G. Thal, Yohei Ohno, Kyong Hee Lee, Dimytri A. Siqueira, Tsuyoshi Kaneko, Morgan T. Harloff, Giuliano Costa, Marco Barbanti, Guilherme F. Attizzani

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

Previous studies reported that new-onset persistent left bundle branch block (NOP-LBBB) was related to worse outcomes after transcatheter aortic valve implantation (TAVI). However, these results can be confounded by the presence of permanent pacemaker (PPM) implantation before and after TAVI. Long-term outcomes and the risk stratification of NOP-LBBB not having PPM implantation before and after TAVI have not been fully investigated. This is an international, multicenter, retrospective study of patients who underwent TAVI from July 31, 2007, to May 8, 2020. A total of 2,240 patients were included, and 17.5% of patients developed NOP-LBBB. NOP-LBBB was associated with cardiac mortality (adjusted hazard ratio [aHR] 1.419, 95% confidence interval [CI] 1.014 to 1.985, p = 0.041) and the composite outcomes of cardiac mortality and/or heart failure readmission (aHR 1.313, 95% CI 1.027 to 1.678, p = 0.030). Patients who developed NOP-LBBB with pre-TAVI left ventricular ejection fraction (LVEF) <40% were significantly associated with cardiac mortality (aHR 2.049, 95% CI 1.039 to 4.041, p = 0.038), heart failure (aHR 3.990, 95% CI 2.362 to 6.741, p <0.001), and the composite outcome (aHR 2.729, 95% CI 1.703 to 4.374, p <0.001). Although NOP-LBBB with pre-TAVI LVEF >40% had a significant decrease in LVEF 6 to 12 months after TAVI (−1.8 ± 9.7% vs +0.6 ± 8.1%, p = 0.003), NOP-LBBB with pre-TAVI LVEF <40% had a significant increase in LVEF 6 to 12 months after TAVI (+9.7 ± 13.6% vs +13.0 ± 11.7%, p = 0.157). In conclusion, patients with NOP-LBBB without pre-TAVI and post-TAVI PPM developed significantly worse long-term outcomes, especially in patients with pre-TAVI LVEF <40%. Further prospective investigation should be undertaken.

Original languageEnglish (US)
Pages (from-to)80-87
Number of pages8
JournalAmerican Journal of Cardiology
Volume175
DOIs
StatePublished - Jul 15 2022

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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