New-onset persistent left bundle branch block following sutureless aortic valve replacement

• Published in: Heart (British Cardiac Society) Vol. 109; no. 2; pp. 143 - 150
• Main Authors: Vilalta, Victoria, Cediel, Germán, Mohammadi, Siamak, López, Helena, Kalavrouziotis, Dimitri, Resta, Helena, Dumont, Eric, Voisine, Pierre, Philippon, François, Escabia, Claudia, Borrellas, Andrea, Alperi, Alberto, Fernandez-Nofrerias, Eduard, Carrillo, Xavier, Panagides, Vassili, Bayes-Genis, Antoni, Rodés-Cabau, Josep
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group Ltd and British Cardiovascular Society 01.01.2023; BMJ Publishing Group LTD
• Subjects: Aortic stenosis; Aortic Valve - diagnostic imaging; Aortic Valve - surgery; Aortic Valve Stenosis; Bundle-Branch Block - diagnosis; Bundle-Branch Block - epidemiology; Bundle-Branch Block - etiology; Cardiac arrhythmia; Cardiology; Cardiovascular disease; Diabetes; Ejection fraction; Heart failure; Heart Valve Prosthesis; Heart Valve Prosthesis - adverse effects; Humans; Mortality; Outcome Assessment, Health Care; Pacemaker, Artificial; Pacemaker, Artificial - adverse effects; Pacemakers; Patients; Population; Prostheses; Risk Factors; Stroke Volume; Sutures; Transcatheter Aortic Valve Replacement - adverse effects; Treatment Outcome; Valvular heart disease; Ventricular Function, Left; Canada; Quebec Canada; Outcome Assessment, Health Care; Heart Valve Prosthesis; Pacemaker, Artificial; Aortic Valve Stenosis
• ISSN: 1355-6037; 1468-201X
• DOI: 10.1136/heartjnl-2022-321191

ObjectiveTo evaluate the incidence, predictive factors and prognostic value of new-onset persistent left bundle branch block (NOP-LBBB) in patients undergoing sutureless surgical aortic valve replacement (SU-SAVR).MethodsA total of 329 consecutive patients without baseline conduction disturbances or previous permanent pacemaker implantation (PPI) who underwent SU-SAVR with the Perceval valve (LivaNova Group, Saluggia, Italy) in two centres from 2013 to 2019 were included. Patients were on continuous ECG monitoring during hospitalisation and 12-lead ECG was performed after the procedure and at hospital discharge. NOP-LBBB was defined as a new postprocedural LBBB that persisted at hospital discharge. Baseline, procedural and follow-up clinical and echocardiography data were collected in a dedicated database.ResultsNew-onset LBBB was observed in 115 (34.9%) patients, and in 76 (23.1%) persisted at hospital discharge. There were no differences in baseline and procedural characteristics between patients with (n=76) and without (n=253) NOP-LBBB. After a median follow-up of 3.3 years (2.3–4.4 years), patients with NOP-LBBB had a higher incidence of PPI (14.5% vs 6.3%, p=0.016), but exhibited similar rates of all-cause mortality (19.4% vs 19.2%, p=0.428), cardiac mortality (8.1% vs 9.4%, p=0.805) and heart failure readmission (21.0% vs 23.2%, p=0.648), compared with the no/transient LBBB group. NOP-LBBB was associated with a decrease in left ventricular ejection fraction (LVEF) at 1-year follow-up (delta: −5.7 vs +0.2, p<0.001).ConclusionsNOP-LBBB occurred in approximately a quarter of patients without prior conduction disturbances who underwent SU-SAVR and was associated with a threefold increased risk of PPI along with a negative impact on LVEF at follow-up.