Impact of Preexisting Left Bundle Branch Block in Transcatheter Aortic Valve Replacement Recipients.
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Fischer Quentin, Himbert Dominique, Webb John G, Eltchaninoff Helene, Muñoz-García Antonio J, Tamburino Corrado, Nombela-Franco Luis, Nietlispach Fabian, Moris Cesar, Ruel Marc, Dager Antonio E, Serra Vicenç, Cheema Asim N, Amat-Santos Ignacio J, de Brito Fabio Sandoli, Ribeiro Henrique, Abizaid Alexandre, Sarmento-Leite Rogério, Dumont Eric, Barbanti Marco, Durand Eric, Alonso Briales Juan H, Bouleti Claire, Immè Sebastiano, Maisano Francesco, Del Valle Raquel, Miguel Benitez Luis, García Del Blanco Bruno, Côté Mélanie, Philippon François, Urena Marina, Rodés-Cabau Josep
Аннотация
METHODS AND RESULTS: This multicenter study evaluated 3404 TAVR candidates according to the presence or absence of LBBB on baseline ECG. TAVR complications and causes of death were defined according to Valve Academic Research Consortium-2 definitions. Follow-up outpatient visits or telephone interviews were conducted at 30 days, 12 months, and yearly thereafter. Echocardiography examinations were performed at baseline, at hospital discharge, and at 1-year follow-up. Preexisting LBBB was present in 398 patients (11.7%) and was associated with an increased risk of permanent pacemaker implantation (PPI; 21.1% versus 14.8%; adjusted odds ratio, 1.51; 95% CI, 1.12-2.04) but not death (7.3% versus 5.5%; adjusted odds ratio, 1.33; 95% CI, 0.84-2.12) at 30 days. At a mean follow-up of 22±21 months, there were no differences between patients with and without preexisting LBBB in overall mortality (adjusted hazard ratio, 0.94; 95% CI, 0.75-1.18) and cardiovascular mortality (adjusted hazard ratio, 0.90; 95% CI, 0.68-1.21). In a subanalysis of 2421 patients without PPI at 30 days and with complete follow-up about the PPI, preexisting LBBB was not associated with an increased risk of PPI or sudden cardiac death. Patients with preexisting LBBB had a lower left ventricular ejection fraction (LVEF) at baseline and at 1-year follow-up ( P <0.001 for both), but those with low LVEF exhibited a similar increase in LVEF over time after TAVR compared with patients with no preexisting LBBB ( P=0.327).
CONCLUSIONS: Preexisting LBBB significantly increased the risk of early (but not late) PPI after TAVR, without any significant effect on overall mortality or cardiovascular mortality. Preexisting LBBB was associated with lower LVEF pre-TAVR but did not prevent an increase in LVEF post-TAVR similar to patients without LBBB.