Impact of New-Onset Persistent Left Bundle Branch Block on Reverse Cardiac Remodeling and Clinical Outcomes After Transcatheter Aortic Valve Replacement

Kyu Kim, Young Guk Ko, Chi Young Shim, Ji Wung Ryu, Yong Joon Lee, Jiwon Seo, Seung Jun Lee, Iksung Cho, Sung Jin Hong, Chul Min Ahn, Jung Sun Kim, Byeong Keuk Kim, Geu Ru Hong, Jong Won Ha, Donghoon Choi, Myeong Ki Hong

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1 Citation (Scopus)

Abstract

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.

Original languageEnglish
Article number893878
JournalFrontiers in Cardiovascular Medicine
Volume9
DOIs
Publication statusPublished - 2022 May 27

Bibliographical note

Publisher Copyright:
Copyright © 2022 Kim, Ko, Shim, Ryu, Lee, Seo, Lee, Cho, Hong, Ahn, Kim, Kim, Hong, Ha, Choi and Hong.

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

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