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Megaly M, Abraham B, Abdelsalam M, Saad M, Omer M, Elbadawi A, Mentias A, Narayanan MA, Gafoor S, Brilakis ES, Goessl M, Cavalcante JL, Garcia S, Kapadia S, Pershad A, Sorajja P, Sengupta J. Short- and Long-Term Outcomes in Patients With New-Onset Persistent Left Bundle Branch Block After Transcatheter Aortic Valve Replacement. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:1299-1304. [PMID: 33246556 DOI: 10.1016/j.carrev.2020.03.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 03/05/2020] [Accepted: 03/05/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND The impact of new-onset persistent left bundle branch block (LBBB) after transcatheter aortic valve replacement (TAVR) on all-cause mortality has been controversial. METHODS We conducted a systematic review and meta-analysis of eleven studies (7398 patients) comparing the short- and long- outcomes in patients who had new-onset LBBB after TAVR vs. those who did not. RESULTS During a mean follow-up of 20.5±14months, patients who had new-onset persistent LBBB after TAVR had a higher incidence of all-cause mortality (29.7% vs. 23.6%; OR 1.28 (1.04-1.58), p=0.02), rehospitalization for heart failure (HF) (19.5% vs. 17.3%; OR 1.4 (1.13-1.73), p=0.002), and permanent pacemaker implantation (PPMi) (19.7% vs. 7.1%; OR 2.4 (1.64-3.52), p<0.001) compared with those who did not. Five studies (4180 patients) reported adjusted hazard ratios (HR) for all-cause mortality; new LBBB remained associated with a higher risk of mortality (adjusted HR 1.43 (1.08-1.9), p<0.01, I2=81%). CONCLUSION Post-TAVR persistent LBBB is associated with higher PPMi, HF hospitalizations, and all-cause mortality. While efforts to identify patients who need post-procedural PPMi are warranted, more studies are required to evaluate the best follow-up and treatment strategies, including the type of pacing device if required, to improve long-term outcomes in these patients.
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Affiliation(s)
- Michael Megaly
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA; Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, MN, USA; Division of Cardiovascular Medicine, Hennepin Healthcare, Minneapolis, MN, USA
| | - Bishoy Abraham
- Division of Internal Medicine, Ascension St. John Hospital, Detroit, MI, USA
| | - Mahmoud Abdelsalam
- Division of Internal Medicine, Temple University/Conemaugh Memorial Medical Center, Johnstown, PA, USA
| | - Marwan Saad
- Division of Cardiovascular Medicine, The Warren Alpert School of Medicine at Brown University, Providence, RI, USA; Division of Cardiology, Ain Shams University, Cairo, Egypt
| | - Mohamed Omer
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA; Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, MN, USA; Division of Cardiovascular Medicine, Hennepin Healthcare, Minneapolis, MN, USA
| | - Ayman Elbadawi
- Division of Cardiology, University of Texas Medical Branch, Galveston, TX, USA
| | - Amgad Mentias
- Division of Cardiovascular Medicine, Roy and Lucille J. Carver College of Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | | | - Sameer Gafoor
- Heart and Vascular Institute, Swedish Medical Centre, Seattle, WA, USA
| | | | - Mario Goessl
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA; Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, MN, USA
| | - João L Cavalcante
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA; Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, MN, USA
| | - Santiago Garcia
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA; Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, MN, USA
| | - Samir Kapadia
- Division of Cardiology, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Ashish Pershad
- Division of Cardiology, Banner University Medical Center, Phoenix, AZ, USA
| | - Paul Sorajja
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA; Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, MN, USA
| | - Jay Sengupta
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA.
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