Post TAVR New Onset Left Bundle Branch Block at Long Term: Worth Our Attention?

After post TAVR mean 3-year follow-up, a new onset persistent left bundle branch block (LBBB) was not associated with higher mortality or hospitalization for cardiac failure according to this study to be published soon in J Am Coll Cardiol Intv. Nevertheless, LBBB was associated to higher risk of definite pacemaker and a negative impact in ventricular function.

The impact of new LBBB remains controversial, especially because there is not data at long term.

This study included 1020 consecutive TAVR patients with no prior conduction disorders or pacemaker who developed a new onset LBBB which persisted at discharge. Patients were followed for mean 3 years (range: 2 to 5 years post TAVR).

New onset LBBB occurred in 212 patients (20.1%) after TAVR. There were no differences in baseline characteristics between both groups of patients, with the exception of a higher use of self-expandable CoreValve in the group presenting conduction disorder (p=0.001).

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At follow-up, there were no differences in all-cause mortality between both groups (new LBBB BCRI 45.3% vs. no LBBB 42.5%; p=0.54), cardiovascular mortality (14.2% vs. 14.4%; p=0.95, respectively) or cardiac failure hospitalization (19.8% vs. 15.6%; p=0.18, respectively).

The new LBBB was associated, as expected, to higher risk of definite pacemaker (15.5% vs. 5.4%; p=0.002), but this was observed especially during the first year after procedure. After that, it seems to plateau.

The conduction disorder also produced a slight ejection fraction deterioration.

Conclusión

After mean 3 year follow up following TAVR, new onset left bundle brunch block was not associated to higher all cause or cardiovascular mortality, or higher hospitalization for cardiac failure, but it was associated to higher pacemaker implantation (especially within the first year) and slight ejection fraction deterioration.

Original Title: Long-Term Outcomes in Patients With New-Onset Persistent Left Bundle Branch Block Following TAVR.

Reference: Chekrallah Chamandi et al. J Am Coll Cardiol Intv 2019. Article in press.

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