Risk Stratification of New Persistent Left Bundle Branch Block After Transcatheter Aortic Valve Implantation
Section snippets
Methods
This is an international, multicenter, retrospective study of consecutive patients who underwent TAVI from July 31, 2007, to May 8, 2020, at the participating hospitals. All patients with preexisting LBBB and cardiac implantable electronic devices (CIEDs) such as PPM, implantable cardioverter-defibrillator, or cardiac resynchronization therapy were excluded from this study, and all CIED implantations after the index TAVI procedure. We collected patient characteristics, pre-TAVI and post-TAVI
Results
At the participating 5 centers during the study duration, 2,240 patients were ultimately included in our analysis (Supplementary Figure 1). The median of the observational period was 1.8 (interquartile range 0.8 to 3.2) years after TAVI, and 393 patients (17.5%) developed NOP-LBBB. The baseline characteristics are listed in Table 1. During the study period, the development of NOP-LBBB was significantly associated with cardiac mortality and the composite outcome of cardiac mortality and/or HF
Discussion
The main findings of the present international, multicenter study are summarized as follows: (1) the development of NOP-LBBB was significantly associated with cardiac mortality and the composite of cardiac mortality and/or HF readmission without cofounding effects from the presence of pre-TAVI and post-TAVI PPM, (2) pre-TAVI LVEF <40% can help stratify the risk of post-TAVI long-term outcomes, and (3) the association of NOP-LBBB and pre-TAVI LVEF <40% was significantly related to worse outcomes.
Disclosures
Dr. Attizzani is a consultant and is on the advisory board of Medtronic. Dr. Mackall has received consulting honoraria from Abbott. Dr. Ohno is a consultant and is on the advisory board of Medtronic. Dr. Kaneko is a consultant/speaker for Edwards Lifesciences, Medtronic, Abbott, Baylis, Cook Medical, 4C medical, and CardioMech. Dr. Barbanti is a consultant for Edwards Lifesciences and an advisory board member for Medtronic. The remaining authors have no conflicts of interest to declare.
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