Long-term follow-up of patients who underwent transcatheter aortic valve replacement (TAVR) and developed left bundle branch block (LBBB) after the procedure seems reassuring. Although it is not benign, it is associated with more conduction defects, more pacemakers, and worsening ventricular function.
Long-term follow-up “partially reassures” the concerns of many physicians about new LBBB after TAVR.
While roughly one in five patients developed a conduction disturbance, there was no difference in clinical events, including mortality or heart failure hospitalizations, at 3 years between patients with new LBBB and those who did not develop LBBB. In any case, there was a higher rate of pacemaker implantation and a reduction in ejection fraction among those who developed new LBBB. Patients who required a pacemaker mainly did it during the first year.
The incidence of LBBB depends on the study, device type, implantation techniques, and patient comorbidities, but data mainly point towards an association with self-expanding valves.
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This new study, presented at EuroPCR 2019 and published simultaneously in JACC: Cardiovascular Interventions, included 1415 consecutive patients who underwent TAVR with a balloon-expandable valve (Sapien, Sapien XT, or Sapien 3; Edwards Lifesciences) or a self-expanding valve (CoreValve or Evolut R; Medtronic) at nine sites between 2007 and 2015.
The final analysis included 1020 cases, since 395 patients were excluded due to failed implantation, conversion to surgery, procedural death, or, in most cases, the implantation of a pacemaker during the index hospitalization.
New LBBB occurred in 461 patients immediately after device release and, of these, LBBB persisted in 212 patients (20.1%). The incidence of LBBB was significantly higher among patients with CoreValve/Evolut R devices.
At 3 years, there was no significant difference in all-cause mortality, cardiovascular mortality, sudden death, or heart failure hospitalizations between those who developed LBBB and those who did not.
There was a difference in pacemaker implantation (15.5% vs. 5.4%; hazard ratio [HR]: 2.45) and it was highest in the first study year, when the risk tripled.
The mean time for pacemaker implantation was 8 months and, after the first year, rates of pacemaker implantation were similar for both groups.
Original Title: Long-term outcomes in patients with new-onset persistent left bundle branch block following TAVR.
Reference: Chamandi C et al. J Am Coll Cardiol Intv. 2019; Epub ahead of print.
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