Effect of New-Onset Left Bundle Branch Block After Transcatheter Aortic Valve Implantation (CoreValve) on Mortality, Frequency of Re-Hospitalization, and Need for Pacemaker

• Published in: The American journal of cardiology 2016-11, Vol.118 (9), p.1380-1385
• Main Authors: López-Aguilera, José, MD, PhD, Segura Saint-Gerons, José M., MD, PhD, Bellido, Francisco Mazuelos, MD, PhD, Suárez de Lezo Herreros de Tejada, Javier, MD, PhD, Pineda, Soledad O., MD, PhD, Pan Álvarez-Ossorio, Manuel, MD, PhD, Ángel Romero Moreno, Miguel, MD, PhD, Pavlovic, Djordje, MD, PhD, de Lezo Cruz Conde, José Suárez, MD, PhD
• Format: Article
• Language: English
• Subjects: Aged; Angina pectoris; Aortic Valve Stenosis - surgery; Bundle-Branch Block - etiology; Bundle-Branch Block - mortality; Cardiac arrhythmia; Cardiovascular; Echocardiography; Electrocardiography; Female; Heart failure; Humans; Longitudinal Studies; Male; Mortality; Pacemaker, Artificial - utilization; Patient Readmission - statistics & numerical data; Patients; Prospective Studies; Transcatheter Aortic Valve Replacement - adverse effects; Variables
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2016.07.057

New-onset conduction disturbances are common after transcatheter aortic valve implantation (TAVI). The most common complication is left bundle branch block (LBBB). The clinical impact of new-onset LBBB after TAVI remains controversial. The aim of this study was to analyze the clinical impact of new-onset LBBB in terms of mortality and morbidity (need for pacemakers and admissions for heart failure) at long-term follow-up. From April 2008 to December 2014, 220 patients who had severe aortic stenosis were treated with the implantation of a CoreValve prosthesis. Sixty-seven of these patients were excluded from the analysis, including 22 patients with pre-existing LBBB and 45 with a permanent pacemaker, implanted previously or within 72 hours of implantation. The remaining 153 patients were divided into 2 groups: group 1 (n = 80), those with persistent new-onset LBBB, and group 2 (n = 73), those without conduction disturbances after treatment. Both groups were followed up at 1 month, 6 months, 12 months, and yearly thereafter. Persistent new-onset LBBB occurred in 80 patients (36%) immediately after TAVI; 73 patients (33%) did not develop conduction disturbances. The mean follow-up time of both groups was 32 ± 22 months (range 3 to 82 months), and there were no differences in time between the groups. There were no differences in mortality between the groups (39% vs 48%, p = 0.58). No differences were observed between the groups in re-hospitalizations for heart failure (11% vs 16%, p = 0.55). Group 1 did not require pacemaker implantation more often at follow-up (10% vs 13%, p = 0.38) than group 2. In conclusion, new-onset LBBB was not associated with a higher incidence of late need for a permanent pacemaker after CoreValve implantation. In addition, it was not associated with a higher risk of late mortality or re-hospitalization.