Long-Term Outcomes After Transcatheter Aortic Valve Replacement Complicated by New-Onset Persistent Left Bundle Branch Block

Abstract

Background

Long-term data on the relevance of new-onset persistent left bundle branch block (pLBBB) after transcatheter aortic valve replacement (TAVR) are sparse. This study aimed to assess the impact of pLBBB that occurs after TAVR on mortality, hospitalisation for heart failure, new permanent pacemaker (PPM) implantation, and left ventricular ejection fraction (LV-EF).

Aims

To investigate the impact of pLBBB on long-term outcomes after TAVR.

Methods

After exclusion of patients with baseline conduction disorders, a pre-existing PPM, valve-in-valve treatment, or in-hospital mortality, a total of 551 patients were analysed. Patients were divided into two groups (pLBBB and no/transient LBBB) and followed over 5 years.

Results

A pLBBB occurred in 85 patients (15%). Patients with pLBBB had a significantly deeper valve implantation (4.0 ± 1.8 mm vs. 3.3 ± 1.8 mm, p < 0.01). pLBBB was associated with an increased risk for hospitalisation for heart failure (HR_adjusted 1.34, 95% CI 1.01−1.76, p = 0.04), whereas all-cause mortality was not elevated. The presence of pLBBB was linked to a significant decline in LV-EF over the follow-up period (58% ± 11% to 55% ± 12%, p = 0.03). There was a trend toward more new PPM implantation but no significant difference (HR_adjusted 1.45, 95% CI 0.96−2.18, p = 0.07). A transient LBBB did not affect the studied outcomes.

Conclusions

During long-term follow-up, patients with a pLBBB were more often hospitalised for heart failure, and experienced a significant reduction in LV-EF in comparison to patients with no or only transient LBBB.