Left Bundle Branch Block Induced by Transcatheter Aortic Valve Implantation Increases Risk of Death
Background—Transcatheter aortic valve implantation (TAVI) is a novel therapy for treating severe aortic stenosis. Although 30-50% of patients develop new left bundle branch block (LBBB), its effect on clinical outcome is unclear.
Methods and Results—Data were collected in a multicenter registry encompassing TAVI-patients from 2005 up to 2010. All-cause mortality rate at follow-up was compared between patients who did and did not develop new LBBB. Of 679 patients analyzed, 387 (57.0%) underwent TAVI with the Medtronic CoreValve System (MCS) and 292 (43.0%) with the Edwards SAPIEN (ES) valve. A total of 233 (34.3%) patients developed new LBBB. Median follow-up was 449.5 (174-834) days in patients with and 450 (253-725) days in patients without LBBB (P=0.90). All-cause mortality was 37.8% (n=88) in patients with and 24.0% (n=107) in patients without LBBB (P=0.002). By multivariate regression analysis, independent predictors of all-cause mortality were: TAVI-induced LBBB (hazard ratio [HR], 1.54, confidence interval [CI], 1.12-2.10), chronic obstructive lung disease (HR, 1.54, CI, 1.13-2.09), female gender (HR, 1.38, CI, 1.04-1.85), left ventricular ejection fraction ≤50% (HR, 1.38, CI, 1.04-1.85) and baseline creatinine (HR, 1.32, CI, 1.19-1.43). LBBB was more frequent after implantation of MCS than after ES (51.1% and 12.0% respectively, P<0.001), but device type did not influence mortality risk of TAVI-induced LBBB.
Conclusions—All-cause mortality after TAVI is higher in patients who develop LBBB than in patients who do not. TAVI-induced LBBB is an independent predictor of mortality.
- Received February 19, 2012.
- Accepted June 1, 2012.
- Copyright © 2012, American Heart Association, Inc. All rights reserved. Unauthorized use prohibited