Impact of new-onset persistent left bundle branch block on late clinical outcomes in patients undergoing transcatheter aortic valve implantation with a balloon-expandable valve

Marina Urena, John G. Webb, Asim Cheema, Vicenç Serra, Stefan Toggweiler, Marco Barbanti, Anson Cheung, Jian Ye, Eric Dumont, Robert Delarochellière, Daniel Doyle, Hatim A. Al Lawati, Marc Peterson, Robert Chisholm, Albert Igual, Henrique Barbosa Ribeiro, Luis Nombela-Franco, François Philippon, Bruno Garcia Del Blanco, Josep Rodés-Cabau

Research output: Contribution to journalArticle

78 Citations (Scopus)

Abstract

Objectives The aim of this study was to determine the impact of new-onset persistent left bundle branch block (NOP-LBBB) on late outcomes after transcatheter aortic valve implantation (TAVI). Background The impact of NOP-LBBB after TAVI remains controversial. Methods A total of 668 consecutive patients who underwent TAVI with a balloon-expandable valve without pre-existing LBBB or permanent pacemaker implantation (PPI) were included. Electrocardiograms were obtained at baseline, immediately after the procedure, and daily until hospital discharge. Patients were followed at 1, 6, and 12 months and yearly thereafter. Results New-onset LBBB occurred in 128 patients (19.2%) immediately after TAVI and persisted at hospital discharge in 79 patients (11.8%). At a median follow-up of 13 months (range 3 to 27 months), there were no differences in mortality rate between the NOP-LBBB and no NOP-LBBB groups (27.8% vs. 28.4%; adjusted-hazard ratio: 0.87 [95% confidence interval (CI): 0.55 to 1.37]; p = 0.54). There were no differences between groups regarding cardiovascular mortality (p = 0.82), sudden death (p = 0.87), rehospitalizations for all causes (p = 0.11), or heart failure (p = 0.55). NOP-LBBB was the only factor associated with an increased rate of PPI during the follow-up period (13.9% vs. 3.0%; hazard ratio: 4.29 [95% CI: 2.03 to 9.07], p < 0.001. NOP-LBBB was also associated with a lack of left ventricular ejection fraction improvement and poorer New York Heart Association functional class at follow-up (p < 0.02 for both). Conclusions NOP-LBBB occurred in ∼1 of 10 patients who had undergone TAVI with a balloon-expandable valve. NOP-LBBB was associated with a higher rate of PPI, a lack of improvement in left ventricular ejection fraction, and a poorer functional status, but did not increase the risk of global or cardiovascular mortality or rehospitalizations at 1-year follow-up.

Original languageEnglish
Pages (from-to)128-136
Number of pages9
JournalJACC: Cardiovascular Interventions
Volume7
Issue number2
DOIs
Publication statusPublished - Feb 2014

Fingerprint

Bundle-Branch Block
Stroke Volume
Mortality
Confidence Intervals
Transcatheter Aortic Valve Replacement
Sudden Death
Electrocardiography
Heart Failure

Keywords

  • aortic stenosis
  • heart failure
  • left bundle branch block
  • permanent pacemaker implantation
  • transcatheter aortic valve implantation
  • transcatheter aortic valve replacement

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Impact of new-onset persistent left bundle branch block on late clinical outcomes in patients undergoing transcatheter aortic valve implantation with a balloon-expandable valve. / Urena, Marina; Webb, John G.; Cheema, Asim; Serra, Vicenç; Toggweiler, Stefan; Barbanti, Marco; Cheung, Anson; Ye, Jian; Dumont, Eric; Delarochellière, Robert; Doyle, Daniel; Al Lawati, Hatim A.; Peterson, Marc; Chisholm, Robert; Igual, Albert; Ribeiro, Henrique Barbosa; Nombela-Franco, Luis; Philippon, François; Garcia Del Blanco, Bruno; Rodés-Cabau, Josep.

In: JACC: Cardiovascular Interventions, Vol. 7, No. 2, 02.2014, p. 128-136.

Research output: Contribution to journalArticle

Urena, M, Webb, JG, Cheema, A, Serra, V, Toggweiler, S, Barbanti, M, Cheung, A, Ye, J, Dumont, E, Delarochellière, R, Doyle, D, Al Lawati, HA, Peterson, M, Chisholm, R, Igual, A, Ribeiro, HB, Nombela-Franco, L, Philippon, F, Garcia Del Blanco, B & Rodés-Cabau, J 2014, 'Impact of new-onset persistent left bundle branch block on late clinical outcomes in patients undergoing transcatheter aortic valve implantation with a balloon-expandable valve', JACC: Cardiovascular Interventions, vol. 7, no. 2, pp. 128-136. https://doi.org/10.1016/j.jcin.2013.08.015
Urena, Marina ; Webb, John G. ; Cheema, Asim ; Serra, Vicenç ; Toggweiler, Stefan ; Barbanti, Marco ; Cheung, Anson ; Ye, Jian ; Dumont, Eric ; Delarochellière, Robert ; Doyle, Daniel ; Al Lawati, Hatim A. ; Peterson, Marc ; Chisholm, Robert ; Igual, Albert ; Ribeiro, Henrique Barbosa ; Nombela-Franco, Luis ; Philippon, François ; Garcia Del Blanco, Bruno ; Rodés-Cabau, Josep. / Impact of new-onset persistent left bundle branch block on late clinical outcomes in patients undergoing transcatheter aortic valve implantation with a balloon-expandable valve. In: JACC: Cardiovascular Interventions. 2014 ; Vol. 7, No. 2. pp. 128-136.
@article{92499be56d814b1991459b1896cae795,
title = "Impact of new-onset persistent left bundle branch block on late clinical outcomes in patients undergoing transcatheter aortic valve implantation with a balloon-expandable valve",
abstract = "Objectives The aim of this study was to determine the impact of new-onset persistent left bundle branch block (NOP-LBBB) on late outcomes after transcatheter aortic valve implantation (TAVI). Background The impact of NOP-LBBB after TAVI remains controversial. Methods A total of 668 consecutive patients who underwent TAVI with a balloon-expandable valve without pre-existing LBBB or permanent pacemaker implantation (PPI) were included. Electrocardiograms were obtained at baseline, immediately after the procedure, and daily until hospital discharge. Patients were followed at 1, 6, and 12 months and yearly thereafter. Results New-onset LBBB occurred in 128 patients (19.2{\%}) immediately after TAVI and persisted at hospital discharge in 79 patients (11.8{\%}). At a median follow-up of 13 months (range 3 to 27 months), there were no differences in mortality rate between the NOP-LBBB and no NOP-LBBB groups (27.8{\%} vs. 28.4{\%}; adjusted-hazard ratio: 0.87 [95{\%} confidence interval (CI): 0.55 to 1.37]; p = 0.54). There were no differences between groups regarding cardiovascular mortality (p = 0.82), sudden death (p = 0.87), rehospitalizations for all causes (p = 0.11), or heart failure (p = 0.55). NOP-LBBB was the only factor associated with an increased rate of PPI during the follow-up period (13.9{\%} vs. 3.0{\%}; hazard ratio: 4.29 [95{\%} CI: 2.03 to 9.07], p < 0.001. NOP-LBBB was also associated with a lack of left ventricular ejection fraction improvement and poorer New York Heart Association functional class at follow-up (p < 0.02 for both). Conclusions NOP-LBBB occurred in ∼1 of 10 patients who had undergone TAVI with a balloon-expandable valve. NOP-LBBB was associated with a higher rate of PPI, a lack of improvement in left ventricular ejection fraction, and a poorer functional status, but did not increase the risk of global or cardiovascular mortality or rehospitalizations at 1-year follow-up.",
keywords = "aortic stenosis, heart failure, left bundle branch block, permanent pacemaker implantation, transcatheter aortic valve implantation, transcatheter aortic valve replacement",
author = "Marina Urena and Webb, {John G.} and Asim Cheema and Vicen{\cc} Serra and Stefan Toggweiler and Marco Barbanti and Anson Cheung and Jian Ye and Eric Dumont and Robert Delarochelli{\`e}re and Daniel Doyle and {Al Lawati}, {Hatim A.} and Marc Peterson and Robert Chisholm and Albert Igual and Ribeiro, {Henrique Barbosa} and Luis Nombela-Franco and Fran{\cc}ois Philippon and {Garcia Del Blanco}, Bruno and Josep Rod{\'e}s-Cabau",
year = "2014",
month = "2",
doi = "10.1016/j.jcin.2013.08.015",
language = "English",
volume = "7",
pages = "128--136",
journal = "JACC: Cardiovascular Interventions",
issn = "1936-8798",
publisher = "Elsevier Inc.",
number = "2",

}

TY - JOUR

T1 - Impact of new-onset persistent left bundle branch block on late clinical outcomes in patients undergoing transcatheter aortic valve implantation with a balloon-expandable valve

AU - Urena, Marina

AU - Webb, John G.

AU - Cheema, Asim

AU - Serra, Vicenç

AU - Toggweiler, Stefan

AU - Barbanti, Marco

AU - Cheung, Anson

AU - Ye, Jian

AU - Dumont, Eric

AU - Delarochellière, Robert

AU - Doyle, Daniel

AU - Al Lawati, Hatim A.

AU - Peterson, Marc

AU - Chisholm, Robert

AU - Igual, Albert

AU - Ribeiro, Henrique Barbosa

AU - Nombela-Franco, Luis

AU - Philippon, François

AU - Garcia Del Blanco, Bruno

AU - Rodés-Cabau, Josep

PY - 2014/2

Y1 - 2014/2

N2 - Objectives The aim of this study was to determine the impact of new-onset persistent left bundle branch block (NOP-LBBB) on late outcomes after transcatheter aortic valve implantation (TAVI). Background The impact of NOP-LBBB after TAVI remains controversial. Methods A total of 668 consecutive patients who underwent TAVI with a balloon-expandable valve without pre-existing LBBB or permanent pacemaker implantation (PPI) were included. Electrocardiograms were obtained at baseline, immediately after the procedure, and daily until hospital discharge. Patients were followed at 1, 6, and 12 months and yearly thereafter. Results New-onset LBBB occurred in 128 patients (19.2%) immediately after TAVI and persisted at hospital discharge in 79 patients (11.8%). At a median follow-up of 13 months (range 3 to 27 months), there were no differences in mortality rate between the NOP-LBBB and no NOP-LBBB groups (27.8% vs. 28.4%; adjusted-hazard ratio: 0.87 [95% confidence interval (CI): 0.55 to 1.37]; p = 0.54). There were no differences between groups regarding cardiovascular mortality (p = 0.82), sudden death (p = 0.87), rehospitalizations for all causes (p = 0.11), or heart failure (p = 0.55). NOP-LBBB was the only factor associated with an increased rate of PPI during the follow-up period (13.9% vs. 3.0%; hazard ratio: 4.29 [95% CI: 2.03 to 9.07], p < 0.001. NOP-LBBB was also associated with a lack of left ventricular ejection fraction improvement and poorer New York Heart Association functional class at follow-up (p < 0.02 for both). Conclusions NOP-LBBB occurred in ∼1 of 10 patients who had undergone TAVI with a balloon-expandable valve. NOP-LBBB was associated with a higher rate of PPI, a lack of improvement in left ventricular ejection fraction, and a poorer functional status, but did not increase the risk of global or cardiovascular mortality or rehospitalizations at 1-year follow-up.

AB - Objectives The aim of this study was to determine the impact of new-onset persistent left bundle branch block (NOP-LBBB) on late outcomes after transcatheter aortic valve implantation (TAVI). Background The impact of NOP-LBBB after TAVI remains controversial. Methods A total of 668 consecutive patients who underwent TAVI with a balloon-expandable valve without pre-existing LBBB or permanent pacemaker implantation (PPI) were included. Electrocardiograms were obtained at baseline, immediately after the procedure, and daily until hospital discharge. Patients were followed at 1, 6, and 12 months and yearly thereafter. Results New-onset LBBB occurred in 128 patients (19.2%) immediately after TAVI and persisted at hospital discharge in 79 patients (11.8%). At a median follow-up of 13 months (range 3 to 27 months), there were no differences in mortality rate between the NOP-LBBB and no NOP-LBBB groups (27.8% vs. 28.4%; adjusted-hazard ratio: 0.87 [95% confidence interval (CI): 0.55 to 1.37]; p = 0.54). There were no differences between groups regarding cardiovascular mortality (p = 0.82), sudden death (p = 0.87), rehospitalizations for all causes (p = 0.11), or heart failure (p = 0.55). NOP-LBBB was the only factor associated with an increased rate of PPI during the follow-up period (13.9% vs. 3.0%; hazard ratio: 4.29 [95% CI: 2.03 to 9.07], p < 0.001. NOP-LBBB was also associated with a lack of left ventricular ejection fraction improvement and poorer New York Heart Association functional class at follow-up (p < 0.02 for both). Conclusions NOP-LBBB occurred in ∼1 of 10 patients who had undergone TAVI with a balloon-expandable valve. NOP-LBBB was associated with a higher rate of PPI, a lack of improvement in left ventricular ejection fraction, and a poorer functional status, but did not increase the risk of global or cardiovascular mortality or rehospitalizations at 1-year follow-up.

KW - aortic stenosis

KW - heart failure

KW - left bundle branch block

KW - permanent pacemaker implantation

KW - transcatheter aortic valve implantation

KW - transcatheter aortic valve replacement

UR - http://www.scopus.com/inward/record.url?scp=84894334122&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84894334122&partnerID=8YFLogxK

U2 - 10.1016/j.jcin.2013.08.015

DO - 10.1016/j.jcin.2013.08.015

M3 - Article

C2 - 24440024

AN - SCOPUS:84894334122

VL - 7

SP - 128

EP - 136

JO - JACC: Cardiovascular Interventions

JF - JACC: Cardiovascular Interventions

SN - 1936-8798

IS - 2

ER -