TY - JOUR
T1 - Long-Term Outcomes in Patients With New-Onset Persistent Left Bundle Branch Block Following TAVR
AU - Chamandi, Chekrallah
AU - Barbanti, Marco
AU - Munoz-Garcia, Antonio
AU - Latib, Azeem
AU - Nombela-Franco, Luis
AU - Gutiérrez-Ibanez, Enrique
AU - Veiga-Fernandez, Gabriela
AU - Cheema, Asim N.
AU - Cruz-Gonzalez, Ignacio
AU - Serra, Vicenç
AU - Tamburino, Corrado
AU - Mangieri, Antonio
AU - Colombo, Antonio
AU - Jiménez-Quevedo, Pilar
AU - Elizaga, Jaime
AU - Lee, Dae Hyun
AU - Garcia del Blanco, Bruno
AU - Puri, Rishi
AU - Côté, Mélanie
AU - Philippon, François
AU - Rodés-Cabau, Josep
N1 - Publisher Copyright:
© 2019 American College of Cardiology Foundation
PY - 2019/6/24
Y1 - 2019/6/24
N2 - 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.
AB - 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.
KW - left bundle branch block
KW - left ventricular ejection fraction
KW - long-term outcomes
KW - pacemaker
KW - transcatheter aortic valve replacement
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U2 - 10.1016/j.jcin.2019.03.025
DO - 10.1016/j.jcin.2019.03.025
M3 - Article
C2 - 31129090
AN - SCOPUS:85067056378
SN - 1936-8798
VL - 12
SP - 1175
EP - 1184
JO - JACC: Cardiovascular Interventions
JF - JACC: Cardiovascular Interventions
IS - 12
ER -