Abstract 11770: Left Bundle Branch Block Induced by Transcatheter Aortic Valve Implantation Increases Risk for 1-Year All-Cause Mortality
Introduction: Transcatheter aortic valve implantation (TAVI) is a valuable therapy in selected patients with severe aortic stenosis. However, ∼30% of patients develop a new left bundle branch block (LBBB).
Hypothesis: We investigated the hypothesis that TAVI-induced LBBB (TAVI+LBBB) increases the risk for all-cause 1-year mortality.
Methods: We retrospectively analyzed case notes, ECGs and local databases of TAVI in 7 centers in the Netherlands on consecutive cases between February 2006 and December 2010. An univariate and multivariate Cox regression analysis was used to determine hazard ratio (HR) and 95% confidence interval (CI) of TAVI+LBBB and covariates (age, gender, baseline creatinin, logistic Euroscore, valve type and quantitative left ventricular function). Cumulative events rates were compared by log-rank test using the Kaplan-Meier method.
Results: Of 841 patients analyzed, 156 were excluded because of pre-existing LBBB, permanent pacemaker (PPM) and/or aborted procedure. In the remaining 679 patients, 225 (33.1%) developed LBBB. Patients without LBBB but requiring permanent pacemaker implantation (n=64) were excluded from further analysis. During mean follow-up of 309±91 days in the 615 analyzed patients, all-cause mortality rate after 1 year was 135 (21.9%) of which 81 in the TAVI group (19.6%) and 54 (26.9%) in the TAVI+LBBB group. The unadjusted log-rank test showed a trend to higher cumulative event rate in the TAVI+LBBB group (log-rank test: p=0.094; Figure). In multivariate regression analysis, the endpoint was predicted by TAVI+LBBB (HR 1.516, CI 1.063-2.162, p=0.022), Euroscore (HR 1.026, CI 1.015-1.036, p<0.0001), creatinin (HR 1.002, CI 1.000-1.004, p=0.012) and female gender (HR 1.486, CI 1.042-2.119, p=0.029).
Conclusions: In conclusion, our data suggest that TAVI-induced LBBB is associated with a 52% increased risk in all-cause mortality at 1 year after implantation presumably due to dyssynchrony related remodeling.
- © 2011 by American Heart Association, Inc.