Early reversal of cardiac remodeling in patients with new-onset persistent left bundle branch block after transcatheter aortic valve replacement

Q: What are the key findings of this study?

New-onset persistent left bundle branch block after TAVR impaired early cardiac reverse remodeling at 6 months, including increased left ventricular mass index and reduced ejection fraction.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Severe aortic stenosis (n=101). Intervention: New-onset persistent left bundle branch block (LBBB) vs. No new-onset LBBB. Primary outcome: Early cardiac reverse remodeling (changes in left ventricular diameter, LVMI, and LVEF) at 6 months (p=<0.05).

Q: What does this research mean for the field?

New-onset persistent left bundle branch block following transcatheter aortic valve replacement adversely affects early postoperative reversal of cardiac remodeling, leading to increased left ventricular diameter and reduced ejection fraction at six months, though it does not impact short-term rehospitalization rates. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To evaluate the impact of new-onset persistent left bundle branch block on early reverse cardiac remodeling and clinical outcomes in patients undergoing transcatheter aortic valve replacement.

Shuzhen Wang; Kunyue Tan; Xiaoqiang Gao; Lijuan Zhang; Chunxia Liu; S. C. Hu; Shuangshuang Yan; Jing Guo; Feng Xiong

doi:10.1186/s13019-026-03961-w

April 5, 2026Journal of Cardiothoracic SurgeryOpen Access

Early reversal of cardiac remodeling in patients with new-onset persistent left bundle branch block after transcatheter aortic valve replacement

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Key result

New-onset persistent LBBB after TAVR is linked to impaired early cardiac reverse remodeling at 6 months.

P<0.05
n=101

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Why the study?

New-onset persistent LBBB following TAVR independently predicts long-term cardiovascular mortality, but its impact on early cardiac reverse remodeling and clinical outcomes remains to be evaluated.

Does new-onset persistent LBBB after TAVR affect early cardiac reverse remodeling and short-term rehospitalization in patients with severe aortic stenosis?

Key Points

To evaluate the impact of new-onset persistent left bundle branch block on early reverse cardiac remodeling and clinical outcomes in patients undergoing transcatheter aortic valve replacement.
Retrospective single-center analysis of 101 patients undergoing successful transcatheter aortic valve replacement for severe aortic stenosis between March 2021 and October 2024.
Serial echocardiographic assessments were conducted preoperatively and at 1 and 6 months post-procedure to monitor chamber dimensions, ejection fraction, and valvular regurgitation.
New-onset persistent left bundle branch block occurred in 28 of 101 patients (27.7%), with lower valve implantation depth independently predicting its occurrence (p < 0.05).
At 6 months, patients with new-onset block showed increased left ventricular end-diastolic diameter and left ventricular mass index with reduced left ventricular ejection fraction (p < 0.05), whereas patients without block exhibited favorable reverse remodeling across all three metrics (p < 0.05).
Mitral regurgitation initially improved at 1 month in both cohorts (p < 0.05), but trended worse at 6 months only in the block group; 6-month rehospitalization rates did not differ significantly between groups (p > 0.05) and no deaths occurred.

Study Design

Type

Cohort (n=101)

Multicenter

No

Structured PICO

Does new-onset persistent LBBB after TAVR affect early cardiac reverse remodeling and short-term rehospitalization in patients with severe aortic stenosis?

P

Population

101 patients older than 61 years with severe aortic stenosis who underwent successful transfemoral transcatheter aortic valve replacement (TAVR) with self-expanding valves. Excluded: history of LBBB or pacemaker, high degree perioperative atrioventricular block, or LBBB reversal within 1 month.

I

Intervention

Development of new-onset persistent left bundle branch block (LBBB) following TAVR

C

Comparator

No development of new-onset persistent LBBB following TAVR

O

Outcome

Early cardiac reverse remodeling (echocardiographic variables including left ventricular diameter, left ventricular mass index, and left ventricular ejection fraction) and rehospitalization rates at 6 months postoperativelysurrogate

Main Result

p-value: p=<0.05

New-onset persistent LBBB after TAVR is associated with adverse early cardiac structural and functional remodeling at 6 months, despite having no significant impact on short-term rehospitalization rates.

Limitations

Single-center surgical experience, which may introduce selection bias
The technology of the center is in the stage of accumulating experience, so physician skill may impact the incidence of new LBBB
Short-term follow-up, meaning the results cannot reflect long-term outcomes
Technology and physician skill at the center are in the stage of accumulating experience, which may impact the incidence of new LBBB
Short-term follow-up cannot reflect long-term outcomes

Implication

May warrant closer LV monitoring in new persistent LBBB post-TAVR; extends long-term mortality associations to early adverse remodeling.

Abstract

Objective New-onset persistent left bundle branch block (LBBB) following transcatheter aortic valve replacement (TAVR) is an independent predictor of long-term cardiovascular mortality in patients. The aim of this study is to evaluate the impact of new-onset LBBB on early cardiac reverse remodeling and clinical outcomes after TAVR. Methods A retrospective analysis was performed on 101 patients who underwent successful TAVR for severe aortic stenosis between March 2021 and October 2024 at our institution. Echocardiographic variables indicative of cardiac remodeling were analysed preoperatively and at one and six months after TAVR. Furthermore, the clinical outcomes of the patients were monitored during the follow-up period. Result Of the 101 patients who underwent TAVR, 28 (27.7%) had new-onset LBBB. Transcatheter heart valve(THV) implantation depth was an influential factor for new LBBB, which was more prevalent in patients with thinner interventricular septal thickness preoperatively. At the six-month follow-up, the new-LBBB group showed an increase in left ventricular diameter and left ventricular mass index and a reduction in left ventricular ejection fraction compared with the preoperative period. Mitral regurgitation in the no-LBBB group was significantly reduced at 1 month postoperatively. In contrast, mitral regurgitation in new-LBBB group was reduced at one month postoperatively, but worsened at six months.There was no significant difference in rehospitalization rates within 6 months postoperatively between patients with or without LBBB. Conclusions New-onset persistent LBBB after TAVR did not affect short-term rehospitalization, but may adversely affect early postoperative reversal of cardiac remodeling.

Discussion

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Cite This Study

Wang et al. (2026) conducted a cohort in Severe aortic stenosis (n=101). New-onset persistent left bundle branch block (LBBB) vs. No new-onset LBBB was evaluated on Early cardiac reverse remodeling (changes in left ventricular diameter, LVMI, and LVEF) at 6 months (p=<0.05). New-onset persistent left bundle branch block after TAVR impaired early cardiac reverse remodeling at 6 months, including increased left ventricular mass index and reduced ejection fraction.

synapsesocial.com/papers/69d49fc5b33cc4c35a2283e3 https://doi.org/10.1186/s13019-026-03961-w

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Early reversal of cardiac remodeling in patients with new-onset persistent left bundle branch block after transcatheter aortic valve replacement

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Early reversal of cardiac remodeling in patients with new-onset persistent left bundle branch block after transcatheter aortic valve replacement

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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