title: Clinical impact of persistent left bundle-branch block after transcatheter aortic valve implantation with CoreValve Revalving System.
abstract: BACKGROUND
  Conduction disturbances are relatively common after transcatheter aortic valve implantation. Previous data demonstrated an adverse impact of persistent left bundle-branch block (LBBB) after surgical aortic valve replacement. It is unclear whether new-onset LBBB may also impact the prognosis of patients after transcatheter aortic valve implantation.
  
  
  RESULTS
  Among 1060 patients treated with a CoreValve Revalving System transcatheter aortic valve implantation between October 2007 and April 2011 in high-volume centers in Italy, we analyzed those without LBBB or pacemaker at admission (879 patients [82.9%]). We further excluded those who underwent permanent pacemaker implantation within 48 hours after the procedure (61 patients [7%]), for a final study population of 818 patients. Among them, 224 patients (group A; 27.4%) developed a persistent LBBB and the remaining 594 (group B; 72.6%) did not. Clinical characteristics were similar between groups. A low implantation was significantly more frequent in group A (15% versus 9.8%, P=0.02). No patients were censored before 1 year (median follow-up period 438 days, interquartile range 174-798 days). Survival analyses and inherent log-rank tests showed that LBBB was not associated with higher all-cause mortality, cardiac mortality, or hospitalization for heart failure at 30 days or 1 year. At 30 days, but not at 1 year, group A had a significantly higher rate of pacemaker implantation.
  
  
  CONCLUSIONS
  In this registry of high-volume centers, persistent LBBB after CoreValve Revalving System transcatheter aortic valve implantation showed no effect on hard end points. On the other hand, LBBB was associated with a higher short-term rate of pacemaker implantation.
authors: Department of Interventional Cardiology, Clinical Institute S. Ambrogio, IRCCS San Donato, 20149 Milan, Italy. luctes@gmail.com
authors: Luca
authors: L
authors: Testa
authors: Azeem
authors: A
authors: Latib
authors: Federico
authors: F
authors: De Marco
authors: Marco
authors: M
authors: De Carlo
authors: Mauro
authors: M
authors: Agnifili
authors: Roberto Adriano
authors: RA
authors: Latini
authors: Anna Sonia
authors: AS
authors: Petronio
authors: Federica
authors: F
authors: Ettori
authors: Arnaldo
authors: A
authors: Poli
authors: Stefano
authors: S
authors: De Servi
authors: Angelo
authors: A
authors: Ramondo
authors: Massimo
authors: M
authors: Napodano
authors: Silvio
authors: S
authors: Klugmann
authors: Gian Paolo
authors: GP
authors: Ussia
authors: Corrado
authors: C
authors: Tamburino
authors: Nedy
authors: N
authors: Brambilla
authors: Antonio
authors: A
authors: Colombo
authors: Francesco
authors: F
authors: Bedogni
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery*; D002037:Bundle-Branch Block / Q000150:complications* / Q000628:therapy; D006328:Cardiac Catheterization / Q000379:methods*; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D010138:Pacemaker, Artificial; D011379:Prognosis; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome