Short- and Long-Term Outcomes in Patients With New-Onset Persistent Left Bundle Branch Block After Transcatheter Aortic Valve Replacement

Michael Megaly, Bishoy Abraham, Mahmoud Abdelsalam, Marwan Saad, Mohamed Omer, Ayman Elbadawi, Amgad Mentias, Mahesh Anantha Narayanan, Sameer Gafoor, Emmanouil S. Brilakis, Mario Goessl, João L. Cavalcante, Santiago Garcia, Samir Kapadia, Ashish Pershad, Paul Sorajja, Jay Sengupta

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Background: The impact of new-onset persistent left bundle branch block (LBBB) after transcatheter aortic valve replacement (TAVR) on all-cause mortality has been controversial. Methods: We conducted a systematic review and meta-analysis of eleven studies (7398 patients) comparing the short- and long- outcomes in patients who had new-onset LBBB after TAVR vs. those who did not. Results: During a mean follow-up of 20.5 ± 14 months, patients who had new-onset persistent LBBB after TAVR had a higher incidence of all-cause mortality (29.7% vs. 23.6%; OR 1.28 (1.04–1.58), p = 0.02), rehospitalization for heart failure (HF) (19.5% vs. 17.3%; OR 1.4 (1.13–1.73), p = 0.002), and permanent pacemaker implantation (PPMi) (19.7% vs. 7.1%; OR 2.4 (1.64–3.52), p < 0.001) compared with those who did not. Five studies (4180 patients) reported adjusted hazard ratios (HR) for all-cause mortality; new LBBB remained associated with a higher risk of mortality (adjusted HR 1.43 (1.08–1.9), p < 0.01, I2 = 81%). Conclusion: Post-TAVR persistent LBBB is associated with higher PPMi, HF hospitalizations, and all-cause mortality. While efforts to identify patients who need post-procedural PPMi are warranted, more studies are required to evaluate the best follow-up and treatment strategies, including the type of pacing device if required, to improve long-term outcomes in these patients.

Original languageEnglish (US)
Pages (from-to)1299-1304
Number of pages6
JournalCardiovascular Revascularization Medicine
Volume21
Issue number10
DOIs
StatePublished - Oct 2020
Externally publishedYes

Keywords

  • LBBB
  • Left bundle branch block
  • TAVI
  • TAVR
  • Transcatheter aortic valve implantation
  • Transcatheter aortic valve replacement

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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