Factors associated with heart failure events in patients with new-onset persistent left bundle branch block at discharge after transcatheter aortic valve replacement.

BACKGROUND

New-onset persistent left bundle branch block (NOP-LBBB) at discharge after transcatheter aortic valve replacement (TAVR) is frequent, but its association with death and hospitalization for heart failure (HHF) remains unclear.

OBJECTIVE

We aimed to assess the association of LBBB persistence or resolution after discharge and of permanent pacemaker (PPM) implantation before discharge with these outcomes.

METHODS

We analyzed consecutive patients undergoing TAVR at Nancy University Hospital from 2009 to 2021 with NOP-LBBB at discharge and available 1-year follow-up. We assessed the association of LBBB persistence (LBBB+) or resolution (LBBB-) at 3 months and in-hospital PPM implantation (PPM+) or absence (PPM-) with the 1-year risk of the composite outcome of mortality or HHF.

RESULTS

Of 1646 TAVR patients, 287 (17.4%) had NOP-LBBB, with complete follow-up data available for 234 patients. Of them, 73 patients (31.2%) required in-hospital PPM implantation, 142 patients (60.7%) experienced LBBB persistence at 3-month follow-up, and 45 (19.2%) had both. The 1-year mortality or HHF rate was 6.3% (PPM-/LBBB-), 10.7% (PPM+/LBBB-), 20.6% (PPM-/LBBB+), and 22.2% (PPM+/LBBB+). LBBB persistence was significantly associated with the composite outcome irrespective of PPM implantation (adjusted hazard ratio [aHR] compared with PPM-/LBBB-: aHR for PPM-/LBBB+, 4.91 [1.64-14.64; P = .004]; aHR for PPM+/LBBB+, 4.58 [1.43-14.68; P = .010]), whereas PPM implantation with LBBB- was not (P = .29). This association was mainly driven by HHF (aHR for PPM-/LBBB+, 8.36 [1.90-36.83; P = .005]; aHR for PPM+/LBBB+, 8.36 [1.80-38.89; P = .007]).

CONCLUSION

The persistence of LBBB beyond discharge, rather than in-hospital PPM implantation, was associated with a higher risk of 1-year mortality or HHF in patients with NOP-LBBB at discharge after TAVR. Assessing postdischarge LBBB persistence may improve prognostic accuracy.