Short- and Long-Term Outcomes in Patients With New-Onset Persistent Left Bundle Branch Block After Transcatheter Aortic Valve Replacement |
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| Institution: | 1. Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA;2. Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, MN, USA;3. Division of Cardiovascular Medicine, Hennepin Healthcare, Minneapolis, MN, USA;4. Division of Internal Medicine, Ascension St. John Hospital, Detroit, MI, USA;5. Division of Internal Medicine, Temple University/Conemaugh Memorial Medical Center, Johnstown, PA, USA;6. Division of Cardiovascular Medicine, The Warren Alpert School of Medicine at Brown University, Providence, RI, USA;7. Division of Cardiology, Ain Shams University, Cairo, Egypt;8. Division of Cardiology, University of Texas Medical Branch, Galveston, TX, USA;9. Division of Cardiovascular Medicine, Roy and Lucille J. Carver College of Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, USA;10. Division of Vascular Medicine, Yale-New Haven Hospital, New Haven, CT, USA;11. Heart and Vascular Institute, Swedish Medical Centre, Seattle, WA, USA;12. Division of Cardiology, Cleveland Clinic Foundation, Cleveland, OH, USA;13. Division of Cardiology, Banner University Medical Center, Phoenix, AZ, USA;1. Division of Cardiology, Westchester Medical Center, Valhalla, New York;2. Department of Cardiovascular Surgery, Mount Sinai Health System, New York, New York;3. Division of Cardiology, Mount Sinai Health System, New York, New York;4. Section of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center, Valhalla, New York;5. Division of Radiology, Westchester Medical Center, Valhalla, New York |
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| Abstract: | BackgroundThe impact of new-onset persistent left bundle branch block (LBBB) after transcatheter aortic valve replacement (TAVR) on all-cause mortality has been controversial.MethodsWe 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.ResultsDuring 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%).ConclusionPost-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. |
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