TY - JOUR
T1 - Short- and Long-Term Outcomes in Patients With New-Onset Persistent Left Bundle Branch Block After Transcatheter Aortic Valve Replacement
AU - Megaly, Michael
AU - Abraham, Bishoy
AU - Abdelsalam, Mahmoud
AU - Saad, Marwan
AU - Omer, Mohamed
AU - Elbadawi, Ayman
AU - Mentias, Amgad
AU - Narayanan, Mahesh Anantha
AU - Gafoor, Sameer
AU - Brilakis, Emmanouil S.
AU - Goessl, Mario
AU - Cavalcante, João L.
AU - Garcia, Santiago
AU - Kapadia, Samir
AU - Pershad, Ashish
AU - Sorajja, Paul
AU - Sengupta, Jay
N1 - Funding Information:
Emmanouil Brilakis: consulting/speaker honoraria from Abbott Vascular, American Heart Association (associate editor Circulation), Biotronik, Boston Scientific, Cardiovascular Innovations Foundation (Board of Directors), CSI, Elsevier, GE Healthcare, InfraRedx, Medtronic, and Teleflex; research support from Regeneron and Siemens. Shareholder: MHI Ventures.
Funding Information:
Santiago Garcia: Consultant for Surmodics, Osprey Medical, Medtronic, Edwards Lifesciences, and Abbott. Dr. Garcia has received grant support from Edwards Lifesciences and the VA Office of Research and Development.
Publisher Copyright:
© 2020 Elsevier Inc.
PY - 2020/10
Y1 - 2020/10
N2 - 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.
AB - 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.
KW - LBBB
KW - Left bundle branch block
KW - TAVI
KW - TAVR
KW - Transcatheter aortic valve implantation
KW - Transcatheter aortic valve replacement
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U2 - 10.1016/j.carrev.2020.03.009
DO - 10.1016/j.carrev.2020.03.009
M3 - Article
C2 - 33246556
AN - SCOPUS:85094948443
SN - 1553-8389
VL - 21
SP - 1299
EP - 1304
JO - Cardiovascular Revascularization Medicine
JF - Cardiovascular Revascularization Medicine
IS - 10
ER -