Clinical Impact of Persistent Left Bundle Branch Block afterTranscatheter Aortic Valve Implantation with CoreValve Revalving System.

BACKGROUND: Conduction disturbances are relatively common after Transcatheter Aortic Valve Implantation (TAVI). Previous data demonstrated an adverse impact of persistent left bundle branch block (LBBB) after surgical aortic valve replacement. It is unclear whether new onset LBBB may also impact on prognosis of patients after TAVI. METHODS AND RESULTS: Among 1060 patients treated with the CoreValve Revalving System (CRS)-TAVI between October 2007 and April 2011 in high volume centers in Italy, we analyzed those without LBBB or pacemaker (PM) at admission (879 patients, 82.7%). Among them, 224 patients (Group A, 27.3%) developed a persistent LBBB and the remaining 594 patients (Group B, 72.7%) did not. Clinical characteristics were similar between groups. A low implantation was significantly more frequent in Group A (15% vs. 9.8%, p=0.02). No patients were censored before one year, median follow-up period 438 days (Interquartile range, 174-798 days). Survival analyses and inherent log rank tests showed that LBBB was not associated with a higher all-cause mortality, cardiac mortality, or hospitalization for heart failure at 30 days and at 1 year. At 30 days, but not at 1 year, Group A had a significantly higher rate of PM implantation. CONCLUSIONS: In this registry of high volume centers, persistent LBBB after CRS-TAVI showed no effect on hard end points. On the other hand, LBBB was associated with a higher short-term rate of PM implantation