Original title: Impact of New-Onset Persistent Left Bundle Branch Block on late Clinical Outcomes in Patients Undergoing Trancatheter Aortic Valve implantation with a Balloon –Expandable Valve. Reference: Urena Marina, el al. JACC Cardiovasc Interv. 2014 Feb;7(2):128-36.

Percutaneous aortic valve implantation brings, sometimes the presence of permanent left bundle branch block (LBBB) that has been associated in some series with the worse prognosis although its true value remains controversial.

In this study, 668 patients who received percutaneous aortic valve implantation with balloon expandable valve were analysed. Of the total, 128 (19.2 %) developed LBBB immediately after the procedure, being persistent after discharge in 79 patients (11.8 %). Those who developed new LBBB were younger, having more hypertension and diabetes, the procedure was performed using the apical via and received larger valves (29 mm), and this last value was a new LBBB predictor. 

In the mean follow-up to 13 (3-27) months, mortality from any cause virtually identical between groups was observed (27.8% versus 28.4%; p = 0.54) as well as re-hospitalizations. There was greater need for permanent pacemaker during follow-up between those who developed LBBB (13.9 % versus 3.0 %,    P < 0.001). The lack of improvement in ejection fraction (EF) and a worse functional class were other differences for those experiencing LBBB. The presence of hypertension, the use of trans – apical access and the presence of a new LBBB, were predictors of less improvement in EF.

Conclusion

The presence of a new permanent left bundle branch block was associated with a higher rate of permanent pacemaker, the lack of improvement in ejection fraction and a worse functional class but did not increase the risk of death from any cause or re-hospitalization to a year. 

Comment

This analysis shows that the new persistent LBBB was associated with the use of larger valves and apical access, probably due to greater local compromise; these was not associated with increased mortality and hospitalization to 12 months, but with larger permanent pacemaker, lower EF and worse functional class. In further analysis of this group of patients, the new LBBB was associated with a worse prognosis in the same period. More research is needed to reach a definitive conclusion.

Courtesy of Carlos Fava MD.
Interventional cardiologist
Favaloro Foundation
Argentina

Dr. Carlos Fava para SOLACI.ORG