Effect of new and persistent left bundle branch block after transcatheter aortic valve replacement on long-term need for pacemaker implantation

Cardiac conduction abnormalities, including left bundle branch block (LBBB), are common following transcatheter aortic valve replacement (TAVR). This study assessed the incidence and outcomes of new or widening persistent LBBB following TAVR. Data regarding 550 consecutive patients undergoing TAVR between 2012 and 2016 at our institution were retrospectively reviewed. Both 30-day and 1-year outcomes of patients with isolated new or worsening LBBB following TAVR were reviewed. Fifty-two patients (9.5%) developed new or worsening LBBB. Six of the 52 (11.5%) patients received a permanent pacemaker (PPM) for LBBB prior to discharge. For patients discharged home following TAVR without a PPM, the 1-year PPM requirement was 15.2% in patients with new or worsening LBBB compared to 4.5% in patients without new or worsening LBBB (P = 0.01). One-year mortality rates for patients who did not have a new PPM placed before discharge were 15.2% in patients with new or worsening LBBB, 13.9% in patients without new or worsening LBBB, and 11.9% in patients with preoperative PPMs (P = 0.81). Patients with new or worsening persistent LBBB discharged without a PPM experience a higher requirement for PPM implantation in the year following TAVR compared to patients without new or worsening persistent LBBB.