Log in to MyACC
New-Onset LBBB After TAVR: PARTNER II Analysis
Study Questions:
What is the clinical impact of developing a new left bundle branch block (LBBB) after balloon-expandable transcatheter aortic valve replacement (TAVR) in intermediate-risk patients with severe aortic stenosis?
Methods:
Data were obtained from the PARTNER II trial and S3 Intermediate-risk registry. Patients surviving to discharge who did not have baseline conduction disturbances, a pre-existing permanent pacemaker (PPM), or required PPM placement prior to discharge were included in the analysis. Clinical outcomes including mortality were compared among those who developed a new persistent LBBB at hospital discharge and those who did not. Multivariate analysis was performed to define clinical predictors of mortality.
Results:
A total of 1,179 patients were included in the analysis. LBBB at discharge was present in 179 (15.2%) patients. At 2 years, LBBB was associated with an increased rate of all-cause mortality (19.3% vs. 10.8%, p = 0.002), cardiovascular mortality (16.2% vs. 6.5%, p < 0.001), rehospitalization, and new PPM implantation. LBBB was an independent predictor of 2-year all-cause (hazard ratio [HR], 1.98; 95% confidence interval [CI], 1.33-2.96; p < 0.001) and cardiovascular (HR, 2.66; 95% CI, 1.67-4.24; p < 0.001) mortality. Patients who developed new LBBB had worse left ventricular (LV) function at 1 and 2 years of follow-up.
Conclusions:
Development of LBBB after TAVR is associated with adverse clinical outcomes including all-cause and cardiovascular mortality.
Perspective:
This is a well-performed retrospective analysis from a robust data set. The clinical relevance of a new LBBB post-TAVR has remained debated. Prior work has not evaluated the intermediate-risk cohort and this finding may be more relevant in the lower-risk patients undergoing TAVR. It should be noted that 40% of patients who developed LBBB at discharge had resolution of the conduction defect at follow-up. In those patients in whom the LBBB persisted, there was a nearly twofold increase in mortality at 2 years. The direct links between LBBB and mortality most likely relate to impact of LBBB on LV function (worse with LBBB than without) and potential issues surrounding need for PPM. Strategies for avoidance, management, and monitoring of patients who develop new LBBB after TAVR need to be explored to optimize outcomes as TAVR moves to lower-risk patients.
Clinical Topics: Arrhythmias and Clinical EP, Cardiac Surgery, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Prevention, Valvular Heart Disease, Implantable Devices, EP Basic Science, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Aortic Surgery, Cardiac Surgery and Arrhythmias, Cardiac Surgery and Heart Failure, Cardiac Surgery and VHD, Acute Heart Failure, Interventions and Structural Heart Disease
Keywords: Aortic Valve Stenosis, Arrhythmias, Cardiac, Bundle-Branch Block, Heart Failure, Heart Valve Diseases, Heart Valve Prosthesis, Pacemaker, Artificial, Secondary Prevention, Treatment Outcome, Transcatheter Aortic Valve Replacement, Ventricular Function, Left
< Back to Listings
