New-onset persistent LBBB after TAVR was associated with a higher incidence of cardiovascular death and heart failure hospitalization compared to no LBBB (HR 5.03; 95% CI 2.60-9.73; p<0.001).
Cohort (n=364)
Does new-onset persistent LBBB after TAVR increase the risk of cardiovascular death and heart failure hospitalization in patients with severe aortic stenosis?
New-onset persistent LBBB after TAVR is associated with a lack of reverse cardiac remodeling and a significantly increased risk of cardiovascular death and heart failure hospitalization.
Hazard Ratio: 5.03 (95% CI 2.6–9.73)
p-value: p=<0.001
Background The clinical implication of new-onset left bundle branch block (LBBB) after transcatheter aortic valve replacement (TAVR) remains controversial. We investigated the impact of new-onset persistent LBBB on reverse cardiac remodeling and clinical outcomes after TAVR. Methods Among 478 patients who had undergone TAVR for symptomatic severe aortic stenosis from 2011 to 2021, we analyzed 364 patients after excluding patients with pre-existing intraventricular conduction disturbance or a pacing rhythm before or during the indexed hospitalization for TAVR. Echocardiographic variables of cardiac remodeling at baseline and 1 year after TAVR were comprehensively analyzed. The primary outcome was a composite of cardiovascular death and hospitalization for heart failure. Secondary outcomes were all-cause death and individual components of the primary outcome. Result New-onset persistent LBBB occurred in 41 (11.3%) patients after TAVR. The no LBBB group showed a significant increase in the left ventricular (LV) ejection fraction and decreases in LV dimensions, the left atrial volume index, and LV mass index 1 year after TAVR (all p 0.001). However, the new LBBB group showed no significant changes in these parameters. During a median follow-up of 18.1 months, the new LBBB group experienced a higher incidence of primary outcomes hazard ratio (HR): 5.03; 95% confidence interval (CI): 2.60–9.73; p 0.001 and all-cause death (HR: 2.80; 95% CI: 1.38–5.69; p = 0.003). The data were similar after multivariable regression analysis. Conclusion New-onset persistent LBBB after TAVR is associated with insufficient reverse cardiac remodeling and increased adverse clinical events.
Kim et al. (Fri,) conducted a cohort in Symptomatic severe aortic stenosis undergoing TAVR (n=364). New-onset persistent left bundle branch block (LBBB) vs. No LBBB was evaluated on Composite of cardiovascular death and hospitalization for heart failure (HR 5.03, 95% CI 2.60-9.73, p=<0.001). New-onset persistent LBBB after TAVR was associated with a higher incidence of cardiovascular death and heart failure hospitalization compared to no LBBB (HR 5.03; 95% CI 2.60-9.73; p<0.001).