New-Onset Persistent LBBB After TAVR

May 22, 2019
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Authors:
Chamandi C, Barbanti M, Munoz-Garcia A, et al.
Citation:
Long-Term Outcomes in Patients With New-Onset Persistent Left Bundle Branch Block Following TAVR. JACC Cardiovasc Interv 2019;May 22:[Epub ahead of print].
Summary By:
Fred Morady, MD, FACC

Study Questions:

What is the clinical impact of new-onset persistent left bundle branch block (NOP-LBBB) after transcatheter aortic valve replacement (TAVR)?

Methods:

In this multicenter cohort study, 1,020 patients without LBBB or a pacemaker underwent TAVR and were followed for a median of 3 years. The outcomes of the study were all-cause mortality, cardiovascular mortality, heart failure (HF) hospitalizations, permanent pacemaker implantation (PPI), and left ventricular ejection fraction (LVEF).

Results:

Two hundred twelve patients (15%) had NOP-LBBB after TAVR and were discharged from the hospital without a PPI. NOP-LBBB occurred more often with a self-expanding Core Valve/Evolut R system (Medtronic) than with a balloon-expanding Edwards system (Edwards Lifesciences, 38% vs. 6%). There were no significant differences during follow-up between the two groups in all-cause mortality, cardiovascular deaths, or HF hospitalizations, but the patients with NOP-LBBB more often underwent PPI (15.5% vs. 5.6%). The PPI rates were 9.4% and 2.7% at 1 year of follow-up in the patients with and without NOP-LBBB, respectively. The PPI rates after the first year of follow-up did not differ between the two groups. The LVEF increased slightly (+1.9%) in patients without NOP-LBBB and decreased slightly (-1.4%) during follow-up in the patients with NOP-LBBB.

Conclusions:

NOP-LBBB after TAVR does not increase the risk of mortality or HF hospitalizations during follow-up but makes it more likely that PPI will be necessary during the first year of follow-up.

Perspective:

Some prior studies have reported that NOP-LBBB after TAVR is associated with a higher risk of death during follow-up while others have not. The results of this large study, which is the first to present 3-year outcomes, are reassuring, at least in regards to survival.

Keywords: Arrhythmias, Cardiac, Bundle-Branch Block, Heart Failure, Heart Valve Diseases, Heart Valve Prosthesis, Pacemaker, Artificial, Stroke Volume, Transcatheter Aortic Valve Replacement


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