title: Impact of New-Onset Left Bundle Branch Block and Periprocedural Permanent Pacemaker Implantation on Clinical Outcomes in Patients Undergoing Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-Analysis.
abstract: BACKGROUND
  Available data on the clinical impact of new-onset left bundle branch block (LBBB) and permanent pacemaker implantation (PPI) after transcatheter aortic valve replacement (TAVR) remains controversial. We aimed to evaluate the impact of (1) periprocedural new-onset LBBB or PPI post-TAVR on cardiac mortality and all-cause 1-year mortality and (2) new-onset LBBB on the need for PPI at 1-year follow-up.
  
  
  RESULTS
  We performed a systematic search from PubMed and EMBASE databases for studies reporting raw data on new-onset LBBB post-TAVR and the need for PPI or mortality at 1-year follow-up, or on 1-year mortality according to the need for periprocedural PPI post-TAVR. Data from 17 studies, including 4756 patients (8 studies) and 7032 patients (11 studies) for the evaluation of the impact of new-onset LBBB and periprocedural PPI post-TAVR were sourced, respectively (with 2 studies used for both outcomes). New-onset LBBB post-TAVR was associated with a higher risk of PPI (risk ratio [RR], 2.18; 95% confidence interval [CI], 1.28-3.70) and cardiac death (RR, 1.39; 95% CI, 1.04-1.86) during follow-up, as well with a tendency toward an increase in all-cause mortality (RR, 1.21; 95% CI, 0.98-1.50). Periprocedural PPI post-TAVR was not associated with any increased risk of all-cause mortality at 1 year (RR, 1.03; 95% CI, 0.9-1.18), yet a tendency toward a protective effect on cardiac death was observed (RR, 0.78; 95% CI, 0.60-1.03).
  
  
  CONCLUSIONS
  New-onset LBBB post-TAVR is a marker of an increased risk of cardiac death and need for PPI at 1-year follow-up. The need for PPI early post-TAVR did not increase the risk of death.
authors.affiliation: From the Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada (A.R., O.A.-J.A., M.d.T., F.C.-P., R.P., F.P., J.R.-C.); and Cardiology Department, Bichat-Claude Bernard Hospital, Paris, France (M.U.).
authors.forename: Ander
authors.initials: A
authors.lastname: Regueiro
authors.affiliation: From the Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada (A.R., O.A.-J.A., M.d.T., F.C.-P., R.P., F.P., J.R.-C.); and Cardiology Department, Bichat-Claude Bernard Hospital, Paris, France (M.U.).
authors.forename: Omar
authors.initials: O
authors.lastname: Abdul-Jawad Altisent
authors.affiliation: From the Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada (A.R., O.A.-J.A., M.d.T., F.C.-P., R.P., F.P., J.R.-C.); and Cardiology Department, Bichat-Claude Bernard Hospital, Paris, France (M.U.).
authors.forename: María
authors.initials: M
authors.lastname: Del Trigo
authors.affiliation: From the Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada (A.R., O.A.-J.A., M.d.T., F.C.-P., R.P., F.P., J.R.-C.); and Cardiology Department, Bichat-Claude Bernard Hospital, Paris, France (M.U.).
authors.forename: Francisco
authors.initials: F
authors.lastname: Campelo-Parada
authors.affiliation: From the Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada (A.R., O.A.-J.A., M.d.T., F.C.-P., R.P., F.P., J.R.-C.); and Cardiology Department, Bichat-Claude Bernard Hospital, Paris, France (M.U.).
authors.forename: Rishi
authors.initials: R
authors.lastname: Puri
authors.affiliation: From the Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada (A.R., O.A.-J.A., M.d.T., F.C.-P., R.P., F.P., J.R.-C.); and Cardiology Department, Bichat-Claude Bernard Hospital, Paris, France (M.U.).
authors.forename: Marina
authors.initials: M
authors.lastname: Urena
authors.affiliation: From the Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada (A.R., O.A.-J.A., M.d.T., F.C.-P., R.P., F.P., J.R.-C.); and Cardiology Department, Bichat-Claude Bernard Hospital, Paris, France (M.U.).
authors.forename: François
authors.initials: F
authors.lastname: Philippon
authors.affiliation: From the Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada (A.R., O.A.-J.A., M.d.T., F.C.-P., R.P., F.P., J.R.-C.); and Cardiology Department, Bichat-Claude Bernard Hospital, Paris, France (M.U.). josep.rodes@criucpq.ulaval.ca.
authors.forename: Josep
authors.initials: J
authors.lastname: Rodés-Cabau
mesh_terms: D001024:Aortic Valve Stenosis / Q000453:epidemiology* / Q000401:mortality; D002037:Bundle-Branch Block / Q000453:epidemiology* / Q000401:mortality; D003643:Death; D006801:Humans; D010138:Pacemaker, Artificial / Q000706:statistics & numerical data*; D016019:Survival Analysis; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects; D016896:Treatment Outcome
keywords: aortic valve stenosis; bundle branch block; cardiac conduction defect; mortality; pacemaker, artificial; transcatheter aortic valve replacement