Author + information
- Received October 22, 2018
- Revision received February 25, 2019
- Accepted March 19, 2019
- Published online June 17, 2019.
- Chekrallah Chamandi, MDa,
- Marco Barbanti, MDb,
- Antonio Munoz-Garcia, MDc,
- Azeem Latib, MDd,
- Luis Nombela-Franco, MDe,
- Enrique Gutiérrez-Ibanez, MDf,
- Gabriela Veiga-Fernandez, MDg,
- Asim N. Cheema, MDh,
- Ignacio Cruz-Gonzalez, MDi,
- Vicenç Serra, MDj,
- Corrado Tamburino, MDb,
- Antonio Mangieri, MDd,
- Antonio Colombo, MDk,
- Pilar Jiménez-Quevedo, MDe,
- Jaime Elizaga, MDf,
- Dae-Hyun Lee, MDg,
- Bruno Garcia del Blanco, MDh,
- Rishi Puri, MBBS, PhDa,
- Mélanie Côté, MSca,
- François Philippon, MDa and
- Josep Rodés-Cabau, MDa,∗ ()
- aQuebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
- bFerrarotto Hospital, University of Catania, Catania, Italy
- cHospital Universitario Virgen de la Victoria, Universidad de Málaga, Malaga, Spain
- dSan Raffaele Scientific Institute, Milan, Italy
- eHospital Universitario Clínico San Carlos, Madrid, Spain
- fHospital Gregorio Maranon, Madrid, Spain
- gHospital Marques de Valldecillas, Santander, Spain
- hSt. Michael’s Hospital, Toronto University, Toronto, Ontario, Canada
- iHospital Universitario de Salamanca, Salamanca, Spain
- jHospital Universitari Vall d’Hebron, Barcelona, Spain
- kVilla Maria Cecilia GVM Hospital, Cotignola, Italy
- ↵∗Address for correspondence:
Dr. Josep Rodés-Cabau, Quebec Heart & Lung Institute, Laval University, 2725 Chemin Ste-Foy, Québec City, Québec G1V 4G5, Canada.
Objectives The aim of this study was to determine the impact of new-onset persistent (NOP) left bundle branch block (LBBB) on long-term (>2 year) outcomes after transcatheter aortic valve replacement (TAVR).
Background The impact of NOP-LBBB after TAVR remains controversial and no data exist regarding long-term outcomes.
Methods A total of 1,020 consecutive patients without pre-existing LBBB or permanent pacemaker implantation (PPI) undergoing TAVR were included. NOP-LBBB was defined as any new LBBB post-TAVR that persisted at hospital discharge. Follow-up clinical and echocardiographic data were obtained at a median of 3 years (interquartile range: 2 to 5 years) post-TAVR.
Results NOP-LBBB occurred in 212 patients (20.1%) following TAVR. There were no differences between NOP-LBBB and no NOP-LBBB groups, except for a higher use of the self-expandable CoreValve system in the NOP-LBBB group (p < 0.001). At follow-up, there were no differences between NOP-LBBB and no NOP-LBBB groups in all-cause mortality (45.3% vs. 42.5%; adjusted hazard ratio [HR]:1.09; 95% confidence interval [CI]: 0.82 to 1.47; p = 0.54), cardiovascular mortality (14.2% vs. 14.4%; adjusted HR: 1.02; 95% CI: 0.56 to 1.87; p = 0.95), or heart failure rehospitalization (19.8% vs. 15.6%; adjusted HR: 1.44; 95% CI: 0.85 to 2.46; p = 0.18). NOP-LBBB was associated with an increased risk of permanent pacemaker implantation at follow-up (15.5% vs. 5.4%; adjusted HR: 2.45; 95% CI: 1.37 to 4.38; p = 0.002), with the highest risk within the first 12 months. Left ventricular ejection fraction increased over time in patients with no NOP-LBBB but slightly decreased in those with NOP-BBB (p < 0.001 for changes in left ventricular ejection fraction between groups).
Conclusions After a median follow-up of 3 years post-TAVR, NOP-LBBB was not associated with a higher mortality or heart failure rehospitalization. However, NOP-LBBB increased the risk of permanent pacemaker implantation and negatively impacted left ventricular function over time. These results should inform future efforts for improving the management of patients with NOP-LBBB post-TAVR.
- left bundle branch block
- left ventricular ejection fraction
- long-term outcomes
- transcatheter aortic valve replacement
Dr. Chamandi has received a fellowship grant from Edwards Lifesciences. Dr. Barbanti is a consultant for Edwards Lifesciences; and is an Advisory Board member for Biotronik. Dr. Latib is an Advisory Board member for Medtronic and Abbott. Dr. Nombela-Franco is a proctor for Abbott. Dr. Rodés-Cabau has received research grants from Edwards Lifesciences and Medtronic; and holds the Research Chair “Fondation Famille Jacques Larivière” for the Development of Structural Heart Disease Interventions. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received October 22, 2018.
- Revision received February 25, 2019.
- Accepted March 19, 2019.
- 2019 American College of Cardiology Foundation
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