Pre-existing left bundle branch block and clinical outcomes after transcatheter aortic valve replacement

Abstract

Background There are currently few reports on pre-existing left bundle branch block (LBBB) in patients undergoing transcatheter aortic valve replacement (TAVR). Nor are there any studies comparing patients with new onset LBBB to those with pre-existing LBBB. This study aimed to investigate the association with pre-existing or new-onset LBBB and clinical outcomes after TAVR. Methods Using data from the Japanese multicenter registry, 5996 patients who underwent TAVR between October 2013 and December 2019 were included. Patients were classified into 3 groups: no LBBB, pre-existing LBBB and new onset LBBB. The 2-year clinical outcomes were compared between 3 groups using Cox proportinal hazard models and propensity score analysis to adjust the differences in baseline characteristics. Results Of 5996 patients who underwent TAVR, 280 patients (4.6%) had pre-existing LBBB and new onset LBBB occurred in 1658 patients (27.6%). Compared with no LBBB group, multivariable Cox regression analysis showed that pre-existing LBBB was associated with a higher 2-year all-cause (adjusted hazard ratio [aHR]: 1.39; 95% confidence interval [CI]: 1.06-1.82; p =0.015) and cardiovascular mortality (aHR: 1.62; 95% CI: 1.05-2.54; p =0.027), but also with higher all-cause (aHR:1.43, 95% CI:1.07-1.91; p =0.016) and cardiovascular mortality (aHR: 1.84, 95% CI: 1.14-2.98; p =0.012) than new onset LBBB group. Heart failure was the most common cause of cardiovascular death, with more heart failure deaths in the pre-existing LBBB group. Conclusions Pre-existing LBBB was independently associated with poor clinical outcomes reflecting increased risk of cardiovascular mortality after TAVR. Patients with pre-existing LBBB should be carefully monitored.

Impact of New‐Onset Right Bundle‐Branch Block After Transcatheter Aortic Valve Replacement on Permanent Pacemaker Implantation

“…Fischer et al reported that prior LBBB was associated with early PPI after TAVR, 30 whereas Saito et al recently reported that there was no association between prior LBBB and PPI. 31 The association between new‐onset LBBB and PPI after TAVR also remains controversial. 7 , 13 , 14 , 15 , 16 Urena et al demonstrated that new‐onset LBBB is associated with the incidence of PPI, 12 whereas Schymik et al demonstrated absence of any association.…”