Original Title: Impact of New-Onset Left Bundle Branch Block and Periprocedural Permanent Pacemaker Implantation on Clinical Outcomes in Patients Undergoing Transcatheter Aortic Valve Replacement. A Systematic Review and Meta-Analysis.
Reference: Ander Regueiro et al. Circ Cardiovasc Interv. 2016 May;9(5).
Available data on the clinical impact of the new-onset left bundle branch block (LBBB) and the need of permanent pacemaker implantation (PPI) after transcatheter aortic valve implantation (TAVI) remain controversial.
The aim of this meta-analyzis was, on one hand, to assess the impact of the new-onset LBBB and PPI on all-cause mortality at one year and, on the other hand, to determine the new-onset LBBB predictive value on the need of PPI.
In all, this meta-analyzis included 17 studies with 11788 patients with data on the impact of the new-onset LBBB and the need of PPI. The new-onset LBBB post TAVI was associated with a greater need of PPI (RR 2.18; CI 95%, 1.28 to 3.70) and a higher risk of cardiac death (RR 1.39; CI 95% 1.04 to 1.86) as well as a tendency to increase all-cause mortality (RR 1.21; CI 95% 0.98 to 1.50).
The need of PPI post TAVI was not associated to an increase in all-cause mortality at one year (RR 1.03; CI 95% 0.9 to 1.18). In fact, it showed a tendency to have a protective effect against cardiac death (RR 0.78; CI 95% 0.60–1.03).
Conclusion
The new-onset left bundle branch block post TAVI is a risk marker of cardiac death and need of PPI at one year follow up. The need of PPI immediately post implantation, was not associated with an increase in mortality.
