Long-term outcomes in patients with left bundle branch block after transcatheter aortic valve replacement

Abstract Introduction New-onset persistent left bundle branch block (NOP-LBBB) is one of the most common complications after transcatheter aortic valve replacement (TAVR). The impact that this conduction disorder may have on the cardiovascular events during the follow-up of these patients remains unclear. Objective The main goal was to assess the prognosis of TAVR recipients that develop persistent LBBB after TAVR, evaluating long-term outcomes. Methods A cohort study was conducted. Consecutive patients undergoing TAVR from January 2012 to December 2020 were included. NOP-LBBB was defined as a new LBBB occurring during the hospitalization period after the TAVR procedure that persisted at hospital discharge. Patients were divided into 2 groups according to whether they had a NOP-LBBB. Patients carrying a pacemaker before the procedure and those who already presented LBBB were excluded. MACE (major adverse cardiovascular events including cardiovascular death, myocardial infarction, cerebrovascular accident and heart failure hospitalization) as primary outcome was searched. Results A total of 254 patients were included with a median age of 81.07 years (77.73–86.22). 77% TAVR patients received self-expanding prosthesis. 21.57% of our cohort presented NOP-LBBB and 29% of this group required a pacemaker. We reported a single case of prosthesis dysfunction, in a patient of the NO-LBBB group. Global baseline characteristics and long term events at follow-up according to the occurrence of LBBB are summarized at figure 1. Patients in both groups were statistically comparable. At a median of 21.3 (8.52–38.94) months of follow-up, a higher incidence of syncope was found among the patients with NO-LBBB, reaching the statistical significance. There were no significant differences between groups regarding cardiovascular mortality (OR 1.48 95% CI: 0.36–4.00 p=0.41). NOP-LBBB group showed higher rates of heart failure hospitalization (OR 1.95 95% CI: 0.98–3.9 p=0.057) NOP-LBBB was associated with an increased risk of MACES at follow-up (27.72% vs 17.54%; adjusted HR: 1.77 95% CI 1.02–3.06, p 0.04). Survival curves are displayed in figure 2. Conclusions Developing LBBB after TAVR seems to lead to more cardiovascular events, with a significant difference in long- term survival. These data suggest an adverse clinical impact of “de novo” LBBB, highlighting the necessity of a close vigilance of these patients. Funding Acknowledgement Type of funding sources: None. Figure 1Figure 2