Impact of New-Onset Persistent Left Bundle Branch Block on Reverse Cardiac Remodeling and Clinical Outcomes After Transcatheter Aortic Valve Replacement

Abstract

BackgroundThe clinical implication of new-onset left bundle branch block (LBBB) after transcatheter aortic valve replacement (TAVR) remains controversial. We investigated the impact of new-onset persistent LBBB on reverse cardiac remodeling and clinical outcomes after TAVR.MethodsAmong 478 patients who had undergone TAVR for symptomatic severe aortic stenosis from 2011 to 2021, we analyzed 364 patients after excluding patients with pre-existing intraventricular conduction disturbance or a pacing rhythm before or during the indexed hospitalization for TAVR. Echocardiographic variables of cardiac remodeling at baseline and 1 year after TAVR were comprehensively analyzed. The primary outcome was a composite of cardiovascular death and hospitalization for heart failure. Secondary outcomes were all-cause death and individual components of the primary outcome.ResultNew-onset persistent LBBB occurred in 41 (11.3%) patients after TAVR. The no LBBB group showed a significant increase in the left ventricular (LV) ejection fraction and decreases in LV dimensions, the left atrial volume index, and LV mass index 1 year after TAVR (all p < 0.001). However, the new LBBB group showed no significant changes in these parameters. During a median follow-up of 18.1 months, the new LBBB group experienced a higher incidence of primary outcomes [hazard ratio (HR): 5.03; 95% confidence interval (CI): 2.60–9.73; p < 0.001] and all-cause death (HR: 2.80; 95% CI: 1.38–5.69; p = 0.003). The data were similar after multivariable regression analysis.ConclusionNew-onset persistent LBBB after TAVR is associated with insufficient reverse cardiac remodeling and increased adverse clinical events.

Cardiac Damage and Conduction Disorders after Transcatheter Aortic Valve Implantation

“…New conduction disturbances are relatively frequent after TAVI, some of them with poor prognosis (slow LVEF recovery, conduction dyssynchrony, AF, prolonged hospitalization) [17][18][19]. Most of our patients had an increase in PR interval and QRS duration after TAVI.…”

“…In recent years, numerous studies have investigated the prognostic impact of the occurrence of a new LBBB after TAVI and have shown diverging results. In recent meta-analyses, no significant correlation has been established between the emergence of TAVI-induced LBBB and mortality from all causes [17][18][19][24][25][26].…”

Near and medium term outcomes of transcatheter aortic valve replacement in elderly patients with aortic stenosis: A meta-analysis

“…High-grade atrioventricular block and new left bundle branch block are often associated with TAVR and require PPI. Studies have shown that PPI increases hospitalization costs after TAVR and is associated with higher cardiac mortality and re-hospitalization for heart failure within 1 year [35] . Auffret et al [36] found that the proportion of patients who underwent PPI after TAVR was related to valve insertion depth, left ventricular septal thickness, preoperative conduction abnormalities, non-calcified aortic valve and other factors.…”

Predictors, clinical impact, and management strategies for conduction abnormalities after transcatheter aortic valve replacement: an updated review

“…Chamandi et al also observed that new-onset persistent left bundle branch block (NOP-LBBB) after TAVR was not correlated with increased all-cause mortality, cardiovascular mortality, or heart failure rehospitalization rates but potentially increased the risk of PPI (15.5% vs. 5.4%; adjusted HR: 2.45; 95% CI: 1.37–4.38; p = 0.002) and worsened left ventricular function (Δ1.9 ± 0.6% vs. Δ1.4 ± 0.9%; p < 0.001 for LVEF over time between groups) ( 74 ). Conversely, some studies revealed an association between new-onset LBBB after TAVR and increased all-cause mortality, PPI rates, and cardiac-related hospitalization rates during the follow-up period ( 86 , 87 ). Intriguingly, Nazif et al, in the PARTNER trial in 2013, reported that new-onset LBBB after TAVR may be independent of 30-day or 1-year all-cause mortality and cardiovascular mortality but was significantly associated with higher repeat hospitalization and PPI rates ( p = 0.01) and reduced LVEF improvement ( p = 0.02) at 1 year after discharge ( 75 ).…”