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New-Onset Left Bundle Branch Block after TAVI: Unveiling its True Clinical Impact
Session:
Sessão de Posters 23 - Pacing após TAVI
Speaker:
André Lobo
Congress:
CPC 2024
Topic:
C. Arrhythmias and Device Therapy
Theme:
09. Device Therapy
Subtheme:
25.3 Non-coronary Cardiac Intervention
Session Type:
Cartazes
FP Number:
---
Authors:
Andre Lobo; Marta Catarina Almeida; Rafael Teixeira; Fábio Nunes; Inês Neves; Marta Leite; Inês Rodrigues; António Gonçalves; Pedro Braga; Ricardo Fontes-Carvalho
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">INTRODUCTION: Cardiac conduction abnormalities frequently follow Transaortic Valve Implantation (TAVI). The need for definitive pacemaker (PM) is a concerning outcome, but development of left bundle branch block (LBBB) also merits attention due to its high prevalence and potential clinical impact. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">AIMS: To assess the incidence and persistence of new-onset LBBB after TAVI, its impact on Left Ventricular Ejection Fraction (LVEF) and the effect on survival.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">METHODS: Single-center retrospective cohort analysis including patients undergoing TAVI from January 2010 to January 2022. The primary outcomes were LBBB development, LBBB persistence, 1-year LVEF variation and all-cause mortality.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">RESULTS: Out of 552 patients, we assessed 431 patients without previous PM (n = 52), LBBB (n = 30), or RBBB (n = 39), which were excluded. Following TAVI, during in-hospital stay, 165 patients (38.3%) developed LBBB, 43 (10.1%) required PM implantation, and 7 (1.6%) developed RBBB. At the one-month evaluation, LBBB persisted in 69 (41.8%) of the 165 cases, with an additional 2 patients developing persistent LBBB. Among other new-onset LBBB patients, 38 (23%) underwent PM implantation, while LBBB had resolved in 58 patients (35.8%), at the 1-month evaluation.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Patients with persistent LBBB exhibited on average a 6.2% inferior LVEF variation (95% CI: -8.1%, -4.5%, p<0.001) at 1-year follow-up compared to those without any rhythm disturbances. Furthermore, the presence of new-onset left ventricular dysfunction at 1-year follow-up was higher in those with new-onset persistent LBBB (16.9%) compared to a minimal 0.01% in patients without any rhythm disturbances (p<0.001). In contrast, patients with only transitory LBBB showed no significant impact on LVEF evolution (p=0.295). In patients with persistent new-onset LBBB, the median survival was 58 months (± 5.4), significantly lower than the 94 months (± 10.4) observed in those without any significant rhythm disturbance development (p<0.001). When assessing patients with both persistent and transitory LBBB together, no significant differences in mortality were identified (p=0.431). Demographic parameters and comorbid conditions exhibited equivalent balance across both groups. The median age was 81 years [IQR: 75-85], with females constituting 56% of the population.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Conclusion: Our study underscores the significance of new-onset LBBB post-TAVI, highlighting its prevalence and clinical impact. With nearly half of new-onset LBBB cases exhibiting persistence, its correlation with worsened LVEF and increased mortality is evident. Recognizing LBBB risk pre-TAVI is crucial for informed treatment decisions, while closer monitoring post-TAVI is also key to the timely identification of those who may benefit from resynchronization therapy.</span></span></p>
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