Left bundle branch block after TAVR hurts outcomes, even when no permanent pacemaker is required
Left bundle branch block (LBBB), one of the most common complications after transcatheter aortic valve replacement (TAVR), is associated with worse patient outcomes. However, because so many of these patients also require a permanent pacemaker (PPM), it is unclear how LBBB affects TAVR patients who do not receive a PPM.
A team of researchers aimed to learn more about this topic, sharing its findings in the American Journal of Cardiology.[1] The group tracked data from more than 2,200 TAVR patients who received care from July 2006 to May 2020. The median follow-up period was nearly two years after TAVR.
Patient who already had a PPM prior to the procedure or received one after the procedure were excluded from the analysis. Patients presenting with LBBB were also excluded; this study was focused on new-onset persistent left bundle branch block (NOP-LBBB).
NOP-LBBB was defined as new LBBB occurring during the patient’s TAVR hospitalization and continuing through hospital discharge. Patients who died during their hospitalization without resolving new LBBB were also included in this cohort.
Overall, 17.5% of patients developed NOP-LBBB. NOP-LBBB was linked to a significant association with cardiovascular mortality and/or hospital admission for heart failure. Patients with a pre-existing left ventricular ejection fraction (LVEF) of less than 40% were also linked to a higher risk of mortality after TAVR.
“Our study showed that pre-TAVR LVEF <40% could potentially stratify long-term outcomes in patients with and without post-TAVR NOP-LBBB,” wrote Takahiro Tsushima, MD, an electrophysiology specialist at the University Hospitals Harrington Heart & Vascular Institute in Cleveland, and colleagues. “Regardless of the type or generation of TAVR prostheses, the development of NOP-LBBB in patients with pre-TAVR LVEF <40% was significantly associated with worse outcomes. To our best knowledge, this is the first study to show that pre-TAVR LVEF <40% could potentially stratify long-term outcomes after TAVR in both patients with and without NOP-LBBB.”
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Michael has more than 18 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.