Persistent LBBB developed in 27.4% of patients after CoreValve TAVI and showed no effect on 1-year mortality or heart failure hospitalization, but increased short-term pacemaker implantation.
Cohort (n=818)
Yes
Does persistent LBBB after TAVI increase mortality or heart failure hospitalization in patients with severe aortic stenosis?
BACKGROUND: Conduction disturbances are relatively common after transcatheter aortic valve implantation. Previous data demonstrated an adverse impact of persistent left bundle-branch block (LBBB) after surgical aortic valve replacement. It is unclear whether new-onset LBBB may also impact the prognosis of patients after transcatheter aortic valve implantation. METHODS AND RESULTS: Among 1060 patients treated with a CoreValve Revalving System transcatheter aortic valve implantation between October 2007 and April 2011 in high-volume centers in Italy, we analyzed those without LBBB or pacemaker at admission (879 patients 82.9%). We further excluded those who underwent permanent pacemaker implantation within 48 hours after the procedure (61 patients 7%), for a final study population of 818 patients. Among them, 224 patients (group A; 27.4%) developed a persistent LBBB and the remaining 594 (group B; 72.6%) did not. Clinical characteristics were similar between groups. A low implantation was significantly more frequent in group A (15% versus 9.8%, P=0.02). No patients were censored before 1 year (median follow-up period 438 days, interquartile range 174-798 days). Survival analyses and inherent log-rank tests showed that LBBB was not associated with higher all-cause mortality, cardiac mortality, or hospitalization for heart failure at 30 days or 1 year. At 30 days, but not at 1 year, group A had a significantly higher rate of pacemaker implantation. CONCLUSIONS: In this registry of high-volume centers, persistent LBBB after CoreValve Revalving System transcatheter aortic valve implantation showed no effect on hard end points. On the other hand, LBBB was associated with a higher short-term rate of pacemaker implantation.
Testa et al. (Wed,) conducted a cohort in Transcatheter aortic valve implantation (n=818). Persistent left bundle-branch block (LBBB) vs. No persistent LBBB was evaluated on All-cause mortality, cardiac mortality, or hospitalization for heart failure at 30 days or 1 year. Persistent LBBB developed in 27.4% of patients after CoreValve TAVI and showed no effect on 1-year mortality or heart failure hospitalization, but increased short-term pacemaker implantation.