Clinical and echocardiographic outcomes with new-onset left bundle branch block after SAPIEN-3 transcatheter aortic valve replacement

Background New-onset left bundle branch block (LBBB) can develop after transcatheter aortic valve replacement (TAVR) resulting in worse outcomes. Aims Describe clinical and echocardiographic outcomes with new-onset LBBB after TAVR. Methods We included consecutive patients who underwent transfemoral-TAVR with SAPIEN-3 (S3) valve between April 2015 and December 2018. Exclusion criteria included pre-existing LBBB, right BBB, left anterior hemiblock, left posterior hemiblock, wide QRS >= 120ms, prior permanent pacemaker (PPM), and nontransfemoral access. Results Among 612 patients, 11.4% developed new-onset LBBB upon discharge. The length of stay was longer with new-onset LBBB compared with no LBBB [3 (2-5) days versus 2 (1-3) days; p < 0.001]. New-onset LBBB was associated with higher rates of 30-day PPM requirement (18.6% vs. 5.4%; p < 0.001) and 1-year heart failure hospitalizations (10.7% vs. 4.4%; p = 0.033). There was no difference in 3-year mortality between both groups (30.9% vs. 30.6%; p = 0.829). Further, new-onset LBBB was associated with lower left ventricular ejection fraction (LVEF) at both 30 days (55.9 +/- 11.4% vs. 59.3 +/- 9%; p = 0.026) and 1 year (55 +/- 12% vs. 60.1 +/- 8.9%; p = 0.002). These changes were still present when we stratified patients according to baseline LVEF (>= 50% or <50%). New-onset LBBBs were associated with a higher 1-year LV end-diastolic volume index (51.4 +/- 18.6 vs. 46.4 +/- 15.1 ml/m(2); p = 0.036), and LV end-systolic volume index (23.2 +/- 14.1 vs. 18.9 +/- 9.7 ml/m(2); p = 0.009). Compared with resolved new-onset LBBB, persistent new-onset LBBB was associated with worse LVEF and higher PPM at 1 year. Conclusions New-onset LBBB after S3 TAVR was associated with higher PPM requirement, worse LVEF, higher LV volumes, and increased heart failure hospitalizations, with no difference in mortality.

Automated summary

This study described the clinical and echocardiographic outcomes of new-onset left bundle branch block (LBBB) after transcatheter aortic valve replacement (TAVR). It found that new-onset LBBB was associated with longer hospital stay, higher requirement for permanent pacemaker (PPM), increased heart failure hospitalizations, lower left ventricular ejection fraction (LVEF), and higher left ventricular volumes. However, there was no difference in mortality between the groups.