Impact of new-onset persistent left bundle branch block on late clinical outcomes in patients undergoing transcatheter aortic valve implantation with a balloon-expandable valve.
OBJECTIVE
The aim of this study was to determine the impact of new-onset persistent left bundle branch block (NOP-LBBB) on late outcomes after transcatheter aortic valve implantation (TAVI).


BACKGROUND
The impact of NOP-LBBB after TAVI remains controversial.


METHODS
A total of 668 consecutive patients who underwent TAVI with a balloon-expandable valve without pre-existing LBBB or permanent pacemaker implantation (PPI) were included. Electrocardiograms were obtained at baseline, immediately after the procedure, and daily until hospital discharge. Patients were followed at 1, 6, and 12 months and yearly thereafter.


RESULTS
New-onset LBBB occurred in 128 patients (19.2%) immediately after TAVI and persisted at hospital discharge in 79 patients (11.8%). At a median follow-up of 13 months (range 3 to 27 months), there were no differences in mortality rate between the NOP-LBBB and no NOP-LBBB groups (27.8% vs. 28.4%; adjusted-hazard ratio: 0.87 [95% confidence interval (CI): 0.55 to 1.37]; p = 0.54). There were no differences between groups regarding cardiovascular mortality (p = 0.82), sudden death (p = 0.87), rehospitalizations for all causes (p = 0.11), or heart failure (p = 0.55). NOP-LBBB was the only factor associated with an increased rate of PPI during the follow-up period (13.9% vs. 3.0%; hazard ratio: 4.29 [95% CI: 2.03 to 9.07], p < 0.001. NOP-LBBB was also associated with a lack of left ventricular ejection fraction improvement and poorer New York Heart Association functional class at follow-up (p < 0.02 for both).


CONCLUSIONS
NOP-LBBB occurred in ∼1 of 10 patients who had undergone TAVI with a balloon-expandable valve. NOP-LBBB was associated with a higher rate of PPI, a lack of improvement in left ventricular ejection fraction, and a poorer functional status, but did not increase the risk of global or cardiovascular mortality or rehospitalizations at 1-year follow-up.
Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
Marina
M
Urena
St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
John G
JG
Webb
St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
Asim
A
Cheema
Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain.
Vicenç
V
Serra
St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
Stefan
S
Toggweiler
St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
Marco
M
Barbanti
St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
Anson
A
Cheung
St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
Jian
J
Ye
Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
Eric
E
Dumont
Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
Robert
R
DeLarochellière
Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
Daniel
D
Doyle
St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
Hatim A
HA
Al Lawati
St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
Marc
M
Peterson
St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
Robert
R
Chisholm
Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain.
Albert
A
Igual
Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
Henrique Barbosa
HB
Ribeiro
Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
Luis
L
Nombela-Franco
Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
François
F
Philippon
Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain.
Bruno
B
Garcia Del Blanco
Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada. Electronic address: josep.rodes@criucpq.ulaval.ca.
Josep
J
Rodés-Cabau
D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D063126:Balloon Valvuloplasty; D002037:Bundle-Branch Block / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D002170:Canada; D006328:Cardiac Catheterization / Q000009:adverse effects* / Q000295:instrumentation* / Q000401:mortality; D002304:Cardiac Pacing, Artificial; D005260:Female; D006333:Heart Failure / Q000209:etiology / Q000503:physiopathology; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation* / Q000401:mortality; D006439:Hemodynamics; D006801:Humans; D008297:Male; D010138:Pacemaker, Artificial; D010359:Patient Readmission; D011474:Prosthesis Design; D018570:Risk Assessment; D012307:Risk Factors; D013030:Spain; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left
aortic stenosis; heart failure; left bundle branch block; permanent pacemaker implantation; transcatheter aortic valve implantation; transcatheter aortic valve replacement