title: Clinical implications of new-onset left bundle branch block after transcatheter aortic valve replacement: analysis of the PARTNER experience.
abstract: OBJECTIVE
  Cardiac conduction disturbances, including a left bundle branch block (LBBB), occur frequently following transcatheter aortic valve replacement (TAVR) and may be associated with adverse clinical events. This analysis examines the incidence and implications of new onset, persistent LBBB in patients undergoing TAVR with a balloon-expandable valve.
  
  
  RESULTS
  Patients undergoing TAVR in the Placement of Aortic Transcatheter Valves (PARTNER) trial and continued access registries with baseline and discharge/7-day electrocardiograms were included. Prior permanent pacemaker implantation (PPI) and baseline intraventricular conduction abnormalities were exclusion criteria. Predictors of new LBBB were identified and outcomes compared between patients with and without new LBBB. New LBBB occurred in 121 of 1151 (10.5%) patients and persisted in more than half at 6 months to 1 year. The only predictor of new LBBB was prior coronary artery bypass grafting. New LBBB was not associated with significant differences in 1-year mortality, cardiovascular mortality, repeat hospitalization, stroke, or myocardial infarction. However, it was associated with increased PPI during hospitalization (8.3 vs 2.8%, P = 0.005) and from discharge to 1 year (4.7 vs. 1.5%, P = 0.01). The ejection fraction failed to improve after TAVR in patients with new LBBB and remained lower at 6 months to 1 year (52.8 vs. 58.1%, P < 0.001).
  
  
  CONCLUSIONS
  Persistent, new-onset LBBB occurred in 10.5% of patients without intraventricular baseline conduction who underwent TAVR in the PARTNER experience. New LBBB was not associated with death, repeat hospitalization, stroke, or myocardial infarction at 1 year, but was associated with a higher rate of PPI and failure of left ventricular ejection fraction to improve.
authors.affiliation: The PARTNER Publications Office and Columbia University Medical Center, 177 Ft. Washington Ave, Room 501, New York, NY 10032, USA.
authors.forename: Tamim M
authors.initials: TM
authors.lastname: Nazif
authors.affiliation: The PARTNER Publications Office and Columbia University Medical Center, 177 Ft. Washington Ave, Room 501, New York, NY 10032, USA.
authors.forename: Mathew R
authors.initials: MR
authors.lastname: Williams
authors.affiliation: The PARTNER Publications Office and Columbia University Medical Center, 177 Ft. Washington Ave, Room 501, New York, NY 10032, USA.
authors.forename: Rebecca T
authors.initials: RT
authors.lastname: Hahn
authors.affiliation: The PARTNER Publications Office and Columbia University Medical Center, 177 Ft. Washington Ave, Room 501, New York, NY 10032, USA.
authors.forename: Samir
authors.initials: S
authors.lastname: Kapadia
authors.affiliation: The PARTNER Publications Office and Columbia University Medical Center, 177 Ft. Washington Ave, Room 501, New York, NY 10032, USA.
authors.forename: Vasilis
authors.initials: V
authors.lastname: Babaliaros
authors.affiliation: The PARTNER Publications Office and Columbia University Medical Center, 177 Ft. Washington Ave, Room 501, New York, NY 10032, USA.
authors.forename: Josep
authors.initials: J
authors.lastname: Rodés-Cabau
authors.affiliation: The PARTNER Publications Office and Columbia University Medical Center, 177 Ft. Washington Ave, Room 501, New York, NY 10032, USA.
authors.forename: Wilson Y
authors.initials: WY
authors.lastname: Szeto
authors.affiliation: The PARTNER Publications Office and Columbia University Medical Center, 177 Ft. Washington Ave, Room 501, New York, NY 10032, USA.
authors.forename: Hasan
authors.initials: H
authors.lastname: Jilaihawi
authors.affiliation: The PARTNER Publications Office and Columbia University Medical Center, 177 Ft. Washington Ave, Room 501, New York, NY 10032, USA.
authors.forename: William F
authors.initials: WF
authors.lastname: Fearon
authors.affiliation: The PARTNER Publications Office and Columbia University Medical Center, 177 Ft. Washington Ave, Room 501, New York, NY 10032, USA.
authors.forename: Danny
authors.initials: D
authors.lastname: Dvir
authors.affiliation: The PARTNER Publications Office and Columbia University Medical Center, 177 Ft. Washington Ave, Room 501, New York, NY 10032, USA.
authors.forename: Todd M
authors.initials: TM
authors.lastname: Dewey
authors.affiliation: The PARTNER Publications Office and Columbia University Medical Center, 177 Ft. Washington Ave, Room 501, New York, NY 10032, USA.
authors.forename: Raj R
authors.initials: RR
authors.lastname: Makkar
authors.affiliation: The PARTNER Publications Office and Columbia University Medical Center, 177 Ft. Washington Ave, Room 501, New York, NY 10032, USA.
authors.forename: Ke
authors.initials: K
authors.lastname: Xu
authors.affiliation: The PARTNER Publications Office and Columbia University Medical Center, 177 Ft. Washington Ave, Room 501, New York, NY 10032, USA.
authors.forename: Jose M
authors.initials: JM
authors.lastname: Dizon
authors.affiliation: The PARTNER Publications Office and Columbia University Medical Center, 177 Ft. Washington Ave, Room 501, New York, NY 10032, USA.
authors.forename: Craig R
authors.initials: CR
authors.lastname: Smith
authors.affiliation: The PARTNER Publications Office and Columbia University Medical Center, 177 Ft. Washington Ave, Room 501, New York, NY 10032, USA.
authors.forename: Martin B
authors.initials: MB
authors.lastname: Leon
authors.affiliation: The PARTNER Publications Office and Columbia University Medical Center, 177 Ft. Washington Ave, Room 501, New York, NY 10032, USA skodali@columbia.edu.
authors.forename: Susheel K
authors.initials: SK
authors.lastname: Kodali
mesh_terms: D000369:Aged, 80 and over; D001021:Aortic Valve; D001024:Aortic Valve Stenosis / Q000503:physiopathology / Q000601:surgery*; D001705:Bioprosthesis / Q000009:adverse effects*; D002037:Bundle-Branch Block / Q000209:etiology*; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D006801:Humans; D008297:Male; D011379:Prognosis; D013318:Stroke Volume / Q000502:physiology; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects*; D016896:Treatment Outcome
keywords: LBBB; Left bundle branch block; PARTNER; Transcatheter aortic valve