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Left Bundle-Branch Block Induced by Transcatheter Aortic Valve Implantation Increases Risk of Death

2012; Lippincott Williams & Wilkins; Volume: 126; Issue: 6 Linguagem: Inglês

10.1161/circulationaha.112.101055

1524-4539

Patrick Houthuizen, Leen van Garsse, Thomas T. Poels, Peter de Jaegere, Robert M.A. van der Boon, Ben M. Swinkels, Jurriën M. ten Berg, Frank van der Kley, Martin J. Schalij, Jan Baan, Ricardo Cocchieri, Guus Brueren, Albert H.M. van Straten, Peter den Heijer, Mohamed Bentala, Vincent van Ommen, Jolanda Kluin, Pieter R. Stella, Martin H. Prins, Jos G. Maessen, Frits W. Prinzen,

Cardiac Arrhythmias and Treatments

Transcatheter aortic valve implantation (TAVI) is a novel therapy for treatment of severe aortic stenosis. Although 30% to 50% of patients develop new left bundle-branch block (LBBB), its effect on clinical outcome is unclear.Data were collected in a multicenter registry encompassing TAVI patients from 2005 until 2010. The 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 and 292 (43.0%) with the Edwards SAPIEN valve. A total of 233 patients (34.3%) developed new LBBB. Median follow-up was 449.5 (interquartile range, 174-834) days in patients with and 450 (interquartile range, 253-725) days in patients without LBBB (P=0.90). All-cause mortality was 37.8% (n=88) in patients with LBBB 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, 1.56; CI, 1.15-2.10), female sex (HR, 1.39; CI, 1.04-1.85), left ventricular ejection fraction ≤50% (HR, 1.38; CI, 1.02-1.86), and baseline creatinine (HR, 1.32; CI, 1.19-1.43). LBBB was more frequent after implantation of the Medtronic CoreValve System than after Edwards SAPIEN implantation (51.1% and 12.0%, respectively; P<0.001), but device type did not influence the mortality risk of TAVI-induced LBBB.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.