What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: Post-transcatheter aortic valve implantation (TAVI). Intervention: New-onset persistent left or right bundle branch block (NOP-LBBB/NOP-RBBB). Primary outcome: Mortality, heart failure rehospitalization, and permanent pacemaker implantation (p=< 0.01).

December 26, 2024Open Access

The Prognostic Relevance of a New Bundle Branch Block After Transcatheter Aortic Valve Implantation: A Systematic Review and Meta-Analysis

Q: What are the key findings of this study?

New-onset persistent left bundle branch block after TAVI is associated with higher mortality and heart failure rehospitalization, and both NOP-LBBB and NOP-RBBB increase pacemaker risk at 1 year.

KRKaran RaoThe University of Sydney MAMohammed AhmedJaypee Institute of Information Technology DBDaniel G BriegerRoyal North Shore Hospital

Key Result

New-onset persistent left bundle branch block after TAVI is associated with higher mortality and heart failure rehospitalization, and both NOP-LBBB and NOP-RBBB increase pacemaker risk at 1 year.

Study Design

Type

Meta-Analysis

Structured PICO

Does new-onset persistent bundle branch block (LBBB or RBBB) increase mortality, heart failure rehospitalization, and pacemaker implantation in patients undergoing TAVI?

Population

22,400 patients undergoing transcatheter aortic valve implantation (TAVI) across 28 studies (18,875 patients in 23 studies for NOP-LBBB analysis; 3,525 patients in 5 studies for NOP-RBBB analysis).

Intervention

New-onset persistent left bundle branch block (NOP-LBBB) or new-onset persistent right bundle branch block (NOP-RBBB) following TAVI.

Comparator

Absence of new persistent bundle branch block after TAVI.

Outcome

All-cause mortality at 1 year.hard clinical

New-onset persistent LBBB after TAVI is associated with increased 1-year mortality, heart failure rehospitalization, and pacemaker implantation, while new-onset persistent RBBB significantly increases the risk of pacemaker implantation at 1 year.

Main Result

p-value: p=< 0.01

Abstract

Background: Interference with the cardiac conduction system is common after transcatheter aortic valve implantation (TAVI), manifesting as atrioventricular block, or more commonly, new-onset persistent left bundle branch block (NOP-LBBB). Bundle branch block results in ventricular dyssynchrony and reduced cardiac output and may be associated with a poorer prognosis. This systematic review and meta-analysis evaluates the prognostic impact of a left or right bundle branch block after TAVI. Methods: A systematic review was performed of the following online databases: PubMed, Medline, Scopus, and Web of Science, including English language studies from 2014 to 2024. Two separate searches for conducted for NOP-LBBB and new-onset persistent right bundle branch block (NOP-RBBB). The Newcastle-Ottawa Scale was used to evaluate risk of bias. Results: < 0.01). Conclusions: NOP-LBBB is associated with higher mortality and heart failure rehospitalization after TAVI, whilst both NOP-LBBB and NOP-RBBB increase the risk of permanent pacemaker implantation at 1 year after TAVI.

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