Author + information
- Received October 22, 2018
- Revision received February 25, 2019
- Accepted March 19, 2019
- Published online May 22, 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 an Advisory Board member for Biotronik. Dr. Latib is an Advisory Board member at Medtronic and Abbott. Dr. Nombela-Franco is a proctor for Abbott. Dr. Rodés-Cabau has received research grants from Edwards Lifesciences and Medtronic. 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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