Mortality and Heart Failure Hospitalization in Patients With Conduction Abnormalities After Transcatheter Aortic Valve Replacement

• Published in: JACC. Cardiovascular interventions Vol. 12; no. 1; pp. 52 - 61
• Main Authors: Jørgensen, Troels H., De Backer, Ole, Gerds, Thomas A., Bieliauskas, Gintautas, Svendsen, Jesper H., Søndergaard, Lars
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 14.01.2019
• Subjects: Aged; Aged, 80 and over; Aortic Valve - physiopathology; Aortic Valve - surgery; bundle branch block; Bundle-Branch Block - mortality; Bundle-Branch Block - physiopathology; Bundle-Branch Block - therapy; Cardiac Pacing, Artificial; Cause of Death; conduction abnormality; Denmark - epidemiology; Female; Heart Failure - mortality; Heart Failure - physiopathology; Heart Failure - therapy; Humans; Incidence; Male; pacemaker; Patient Readmission; Prospective Studies; Registries; Risk Assessment; Risk Factors; Stroke Volume; Time Factors; transcatheter aortic valve replacement; Transcatheter Aortic Valve Replacement - adverse effects; Transcatheter Aortic Valve Replacement - mortality; Treatment Outcome; Ventricular Function, Left; Denmark; pacemaker; BBB; THV; CI; LVEF; HR; conduction abnormality; IQR; PPM; PVR; RVP; TAVR; LBBB; RBBB; transcatheter aortic valve replacement; bundle branch block; CA
• ISSN: 1936-8798; 1876-7605
• DOI: 10.1016/j.jcin.2018.10.053

The aim of this study was to assess mortality and rehospitalization in patients with new bundle branch block (BBB) and/or permanent pacemaker (PPM) after transcatheter aortic valve replacement (TAVR). Previous studies have provided inconsistent results on the clinical impact of new BBB or new PPM after TAVR. A total of 816 consecutive patients without pre-procedural BBB or PPM undergoing TAVR between 2007 and 2017 were followed for 5 years or until data extraction in September 2017. Data on vital status and hospitalization were obtained through national registries. Within 30 days post-TAVR, new BBB without PPM and new PPM occurred in 247 (30.3%) and 132 (16.2%) patients, respectively, leaving 437 patients (53.6%) without conduction abnormalities. Median follow-up was 2.5 years (interquartile range: 1.0 to 4.9 years). One-year all-cause mortality was increased for new BBB (hazard ratio [HR]: 2.80; 95% confidence interval [CI]: 1.18 to 3.67) but not for new PPM (HR: 1.64; 95% CI: 0.72 to 3.74) compared with patients with no conduction abnormalities. The risk for late all-cause mortality (≥1 year after TAVR) was higher both for patients with new BBB (HR: 1.79; 95% CI: 1.24 to 2.59) and for those with new PPM (HR: 1.58; 95% CI: 1.01 to 2.46) compared with patients with no conduction abnormalities. Patients with new BBB (HR: 1.47; 95% CI: 1.02 to 2.12) and new PPM (HR: 1.66; 95% CI: 1.09 to 2.54) had a higher risk for heart failure hospitalization and reduced left ventricular ejection fraction (p < 0.0001 for both groups) during follow-up. New BBB and new PPM developed frequently after TAVR. New BBB was associated with increased early and late all-cause mortality, whereas new PPM was associated with late all-cause mortality. Furthermore, both new BBB and new PPM increased the risk for heart failure hospitalizations. [Display omitted]