title: Effect of New-Onset Left Bundle Branch Block After Transcatheter Aortic Valve Implantation (CoreValve) on Mortality, Frequency of Re-Hospitalization, and Need for Pacemaker.
abstract: New-onset conduction disturbances are common after transcatheter aortic valve implantation (TAVI). The most common complication is left bundle branch block (LBBB). The clinical impact of new-onset LBBB after TAVI remains controversial. The aim of this study was to analyze the clinical impact of new-onset LBBB in terms of mortality and morbidity (need for pacemakers and admissions for heart failure) at long-term follow-up. From April 2008 to December 2014, 220 patients who had severe aortic stenosis were treated with the implantation of a CoreValve prosthesis. Sixty-seven of these patients were excluded from the analysis, including 22 patients with pre-existing LBBB and 45 with a permanent pacemaker, implanted previously or within 72 hours of implantation. The remaining 153 patients were divided into 2 groups: group 1 (n = 80), those with persistent new-onset LBBB, and group 2 (n = 73), those without conduction disturbances after treatment. Both groups were followed up at 1 month, 6 months, 12 months, and yearly thereafter. Persistent new-onset LBBB occurred in 80 patients (36%) immediately after TAVI; 73 patients (33%) did not develop conduction disturbances. The mean follow-up time of both groups was 32 ± 22 months (range 3 to 82 months), and there were no differences in time between the groups. There were no differences in mortality between the groups (39% vs 48%, p = 0.58). No differences were observed between the groups in re-hospitalizations for heart failure (11% vs 16%, p = 0.55). Group 1 did not require pacemaker implantation more often at follow-up (10% vs 13%, p = 0.38) than group 2. In conclusion, new-onset LBBB was not associated with a higher incidence of late need for a permanent pacemaker after CoreValve implantation. In addition, it was not associated with a higher risk of late mortality or re-hospitalization.
authors.affiliation: Reina Sofia University Hospital, Maimonides Institute for Biomedical Research, University of Cordoba, Córdoba, Spain. Electronic address: mircardjla@gmail.com.
authors.forename: José
authors.initials: J
authors.lastname: López-Aguilera
authors.affiliation: Reina Sofia University Hospital, Maimonides Institute for Biomedical Research, University of Cordoba, Córdoba, Spain.
authors.forename: José M
authors.initials: JM
authors.lastname: Segura Saint-Gerons
authors.affiliation: Reina Sofia University Hospital, Maimonides Institute for Biomedical Research, University of Cordoba, Córdoba, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Mazuelos Bellido
authors.affiliation: Reina Sofia University Hospital, Maimonides Institute for Biomedical Research, University of Cordoba, Córdoba, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Suárez de Lezo Herreros de Tejada
authors.affiliation: Reina Sofia University Hospital, Maimonides Institute for Biomedical Research, University of Cordoba, Córdoba, Spain.
authors.forename: Soledad O
authors.initials: SO
authors.lastname: Pineda
authors.affiliation: Reina Sofia University Hospital, Maimonides Institute for Biomedical Research, University of Cordoba, Córdoba, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Pan Álvarez-Ossorio
authors.affiliation: Reina Sofia University Hospital, Maimonides Institute for Biomedical Research, University of Cordoba, Córdoba, Spain.
authors.forename: Miguel Ángel
authors.initials: MÁ
authors.lastname: Romero Moreno
authors.affiliation: Reina Sofia University Hospital, Maimonides Institute for Biomedical Research, University of Cordoba, Córdoba, Spain.
authors.forename: Djordje
authors.initials: D
authors.lastname: Pavlovic
authors.affiliation: Reina Sofia University Hospital, Maimonides Institute for Biomedical Research, University of Cordoba, Córdoba, Spain.
authors.forename: José
authors.initials: J
authors.lastname: Suárez de Lezo Cruz Conde
mesh_terms: D000368:Aged; D001024:Aortic Valve Stenosis / Q000601:surgery*; D002037:Bundle-Branch Block / Q000209:etiology* / Q000401:mortality*; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D010138:Pacemaker, Artificial / Q000706:statistics & numerical data*; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011446:Prospective Studies; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects*