The Prognostic Impact of New-Onset Persistent Left Bundle Branch Block Following Transcatheter Aortic Valve Implantation: A Meta-analysis

Clin Cardiol. 2016 Sep;39(9):544-50. doi: 10.1002/clc.22567. Epub 2016 Jul 19.

Abstract

New-onset persistent left bundle branch block (NOP-LBBB) is one of the most common conduction disturbances after transcatheter aortic valve implantation (TAVI). We hypothesized that NOP-LBBB may have a clinically negative impact after TAVI. To find out, we conducted a systematic literature search of the MEDLINE/PubMed and Embase databases. Observational studies that reported clinical outcomes of NOP-LBBB patients after TAVI were included. The random-effects model was used to combine odds ratios, risk ratios, or hazard ratios (HRs) with 95% confidence intervals. Adjusted HRs were utilized over unadjusted HRs or risk ratios when available. A total of 4049 patients (807 and 3242 patients with and without NOP-LBBB, respectively) were included. Perioperative (in-hospital or 30-day) and midterm all-cause mortality and midterm cardiovascular mortality were comparable between the groups. The NOP-LBBB patients experienced a higher rate of permanent pacemaker implantation (HR: 2.09, 95% confidence interval: 1.12-3.90, P = 0.021, I(2) = 83%) during midterm follow-up. We found that NOP-LBBB after TAVI resulted in higher permanent pacemaker implantation but did not negatively affect the midterm prognosis. Therefore, careful observation during the follow-up is required.

Publication types

  • Meta-Analysis
  • Review

MeSH terms

  • Aged
  • Aged, 80 and over
  • Aortic Valve* / physiopathology
  • Bundle-Branch Block / etiology*
  • Bundle-Branch Block / mortality
  • Bundle-Branch Block / physiopathology
  • Bundle-Branch Block / therapy
  • Cardiac Catheterization / adverse effects*
  • Cardiac Catheterization / instrumentation
  • Cardiac Catheterization / mortality
  • Cardiac Pacing, Artificial
  • Female
  • Heart Valve Prosthesis
  • Heart Valve Prosthesis Implantation / adverse effects*
  • Heart Valve Prosthesis Implantation / instrumentation
  • Heart Valve Prosthesis Implantation / mortality
  • Hospital Mortality
  • Humans
  • Male
  • Observational Studies as Topic
  • Odds Ratio
  • Pacemaker, Artificial
  • Risk Assessment
  • Risk Factors
  • Time Factors
  • Treatment Outcome