Prognosis of new-onset left bundle branch block after transcatheter aortic valve replacement in patients with aortic stenosis: A systematic review and meta-analysis_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

WANG Jialu ¹ , LIU Shidong ² , HAN Xiangxiang ¹ , LEI Xiang ¹ , FANG Tao ¹ , DONG Shuai ² ,  SONG Bing ²

1. The First Clinical Medical College of Lanzhou University, Lanzhou, 730000. P. R. China;
2. Department of Cardiovascular Surgery, The First Hospital of Lanzhou University, Lanzhou, 730000. P. R. China;

Corresponding author：

SONG Bing, Email: songbingldyy@163.com

Keywords：

Transcatheter aortic valve replacement; left bundle branch block; prognosis; systematic review/meta-analysis

DOI：

10.7507/1007-4848.202009093

Video：

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Objective To systematically review the clinical outcome of patients with new-onset left bundle branch block (LBBB) following transcatheter aortic valve replacement (TAVR).Methods Electronic search was performed in PubMed, EMbase, Cochrane Library, Web of Science, CNKI, Wanfang and CBM databases to identify studies about the new-onset LBBB after TAVR from inception to March 19, 2022. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then, meta-analysis was performed by using Stata 15.0 software.Results A total of 17 cohort studies were included, covering 9 205 patients, including 2 202 patients with new-onset LBBB and 7 003 without new-onset LBBB after TAVR. The results of meta-analysis showed that patients with new-onset LBBB after TAVR at 30-day (RR=1.65, 95%CI 1.30 to 2.10, P<0.001) and 1-year (RR=1.30, 95%CI 1.16 to 1.45, P<0.001) all-cause mortality was higher than no new-onset LBBB group. One-year cardiovascular mortality was higher in the new-onset LBBB group (RR=1.47, 95%CI 1.21 to 1.79, P<0.001). In the occurrence of 30-day (RR=1.51, 95%CI 1.10 to 2.08, P=0.011) and 1-year (RR=1.34, 95%CI 1.14 to 1.58, P=0.001) rehospitalization rate, 30-day (RR=3.05, 95% CI 1.49 to 6.22, P=0.002) and 1-year (RR=2.15, 95%CI 1.52 to 3.03, P<0.001) pacemaker implantation, the incidence of patients with new-onset LBBB was higher than that of the no new-onset LBBB group.Conclusion Compared with the patients without LBBB after TAVR, the clinical prognosis of patients with new-onset LBBB after TAVR is poor. In the future, the management and follow-up of the patients with LBBB after TAVR should be further strengthened to improve the prognosis of patients.

Citation： WANG Jialu, LIU Shidong, HAN Xiangxiang, LEI Xiang, FANG Tao, DONG Shuai, SONG Bing. Prognosis of new-onset left bundle branch block after transcatheter aortic valve replacement in patients with aortic stenosis: A systematic review and meta-analysis. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2022, 29(5): 624-633. doi: 10.7507/1007-4848.202009093 Copy

1.	Kanwar A, Thaden JJ, Nkomo VT. Management of patients with aortic valve stenosis. Mayo Clin Proc, 2018, 93(4): 488-508.
2.	Eveborn GW, Schirmer H, Heggelund G, et al. The evolving epidemiology of valvular aortic stenosis. Tromsø study. Heart, 2013, 99(6): 396-400.
3.	李伯慧, 何宇欣, 刘先宝, 等. 主动脉瓣钙化相关的经导管主动脉瓣置换术并发症的现状与进展. 心电与循环, 2020, 39(3): 304-309.
4.	Iung B, Cachier A, Baron G, et al. Decision-making in elderly patients with severe aortic stenosis: Why are so many denied surgery? Eur Heart J, 2005, 26(24): 2714-2720.
5.	张倩, 王墨扬, 吴永健. 《经导管主动脉瓣置换术中国专家共识(2020更新版)》解读. 华西医学, 2021, 36(9): 1191-1195.
6.	施浩, 王首正, 谢涌泉. 未来已来: 经导管主动脉瓣置换术在中低危患者的临床应用现状和前景. 中国胸心血管外科临床杂志, 2019, 26(11): 1060-1062.
7.	Massoullié G, Bordachar P, Ellenbogen KA, et al. New-onset left bundle branch block induced by transcutaneous aortic valve implantation. Am J Cardiol, 2016, 117(5): 867-873.
8.	Auffret V, Puri R, Urena M, et al. Conduction disturbances after transcatheter aortic valve replacement: Current status and future perspectives. Circulation, 2017, 136(11): 1049-1069.
9.	Jochheim D, Zadrozny M, Theiss H, et al. Aortic regurgitation with second versus third-generation balloon-expandable prostheses in patients undergoing transcatheter aortic valve implantation. EuroIntervention, 2015, 11(2): 214-220.
10.	Auffret V, Martins RP, Daubert C, et al. Idiopathic/iatrogenic left bundle branch block-induced reversible left ventricle dysfunction: JACC state-of-the-art review. J Am Coll Cardiol, 2018, 72(24): 3177-3188.
11.	Zannad F, Huvelle E, Dickstein K, et al. Left bundle branch block as a risk factor for progression to heart failure. Eur J Heart Fail, 2007, 9(1): 7-14.
12.	Regueiro A, Abdul-Jawad Altisent O, Del Trigo M, et al. Impact of new-onset left bundle branch block and periprocedural permanent pacemaker implantation on clinical outcomes in patients undergoing transcatheter aortic valve replacement: A systematic review and meta-analysis. Circ Cardiovasc Interv, 2016, 9(5): e003635.
13.	Faroux L, Chen S, Muntane-Carol G, et al. Clinical impact of conduction disturbances in transcatheter aortic valve replacement recipients: A systematic review and meta-analysis. Eur Heart J, 2020, 41(29): 2771-2781.
14.	Søndergaard L, Steinbrüchel DA, Ihlemann N, et al. Two-year outcomes in patients with severe aortic valve stenosis randomized to transcatheter versus surgical aortic valve replacement: The all-comers nordic aortic valve intervention randomized clinical trial. Circ Cardiovasc Interv, 2016, 9(6): e003665.
15.	Cota GF, de Sousa MR, Fereguetti TO, et al. Efficacy of anti-leishmania therapy in visceral leishmaniasis among HIV infected patients: A systematic review with indirect comparison. PLoS Negl Trop Dis, 2013, 7(5): e2195.
16.	Testa L, Latib A, De Marco F, et al. Clinical impact of persistent left bundle-branch block after transcatheter aortic valve implantation with corevalve revalving system. Circulation, 2013, 127(12): 1300-1307.
17.	Nazif TM, Williams MR, Hahn RT, et al. Clinical implications of new-onset left bundle branch block after transcatheter aortic valve replacement: Analysis of the partner experience. Eur Heart J, 2014, 35(24): 1599-1607.
18.	Franzoni I, Latib A, Maisano F, et al. Comparison of incidence and predictors of left bundle branch block after transcatheter aortic valve implantation using the corevalve versus the edwards valve. Am J Cardiol, 2013, 112(4): 554-559.
19.	Houthuizen P, van der Boon RM, Urena M, et al. Occurrence, fate and consequences of ventricular conduction abnormalities after transcatheter aortic valve implantation. EuroIntervention, 2014, 9(10): 1142-1150.
20.	Akdemir B, Roukoz H. A single-centre cohort and short-term follow-up of patients who developed persistent new onset left bundle branch block after transcatheter aortic valve replacement. Acta Cardiol, 2020, 75(4): 360-365.
21.	Sasaki K, Izumo M, Kuwata S, et al. Clinical impact of new-onset left bundle-branch block after transcatheter aortic valve implantation in the Japanese population —A single high-volume center experience. Circ J, 2020, 84(6): 1012-1019.
22.	Hamandi M, Tabachnick D, Lanfear AT, et al. Effect of new and persistent left bundle branch block after transcatheter aortic valve replacement on long-term need for pacemaker implantation. Proc (Bayl Univ Med Cent), 2020, 33(2): 157-162.
23.	Jørgensen TH, De Backer O, Gerds TA, et al. Mortality and heart failure hospitalization in patients with conduction abnormalities after transcatheter aortic valve replacement. JACC Cardiovasc Interv, 2019, 12(1): 52-61.
24.	Houthuizen P, Van Garsse LA, Poels TT, et al. Left bundle-branch block induced by transcatheter aortic valve implantation increases risk of death. Circulation, 2012, 126(6): 720-728.
25.	Schymik G, Tzamalis P, Bramlage P, et al. Clinical impact of a new left bundle branch block following TAVI implantation: 1-year results of the TAVI cohort. Clin Res Cardiol, 2015, 104(4): 351-362.
26.	Urena M, Webb JG, Cheema A, et al. Impact of new-onset persistent left bundle branch block on late clinical outcomes in patients undergoing transcatheter aortic valve implantation with a balloon-expandable valve. JACC Cardiovasc Interv, 2014, 7(2): 128-136.
27.	Carrabba N, Valenti R, Migliorini A, et al. Impact on left ventricular function and remodeling and on 1-year outcome in patients with left bundle branch block after transcatheter aortic valve implantation. Am J Cardiol, 2015, 116(1): 125-131.
28.	Kessler M, Gonska B, Seeger J, et al. Long-term clinical outcome of persistent left bundle branch block after transfemoral aortic valve implantation. Catheter Cardiovasc Interv, 2019, 93(3): 538-544.
29.	Chamandi C, Barbanti M, Munoz-Garcia A, et al. Long-term outcomes in patients with new-onset persistent left bundle branch block following TAVR. JACC Cardiovasc Interv, 2019, 12(12): 1175-1184.
30.	Nazif TM, Chen S, George I, et al. New-onset left bundle branch block after transcatheter aortic valve replacement is associated with adverse long-term clinical outcomes in intermediate-risk patients: An analysis from the partner Ⅱ trial. Eur Heart J, 2019, 40(27): 2218-2227.
31.	Eschalier R, Massoullié G, Nahli Y, et al. New-onset left bundle branch block after TAVI has a deleterious impact on left ventricular systolic function. Can J Cardiol, 2019, 35(10): 1386-1393.
32.	López-Aguilera J, Segura Saint-Gerons JM, Mazuelos Bellido F, et al. Effect of new-onset left bundle branch block after transcatheter aortic valve implantation (corevalve) on mortality, frequency of re-hospitalization, and need for pacemaker. Am J Cardiol, 2016, 118(9): 1380-1385.
33.	王勇, 张辰, 刘婷, 等. 应用venus-a瓣膜行经导管主动脉瓣置换术后传导阻滞患者特征和心脏解剖结构分析. 华西医学, 2020, 35(9): 1044-1049.
34.	Boerlage-Van Dijk K, Kooiman KM, Yong ZY, et al. Predictors and permanency of cardiac conduction disorders and necessity of pacing after transcatheter aortic valve implantation. Pacing Clin Electrophysiol, 2014, 37(11): 1520-1529.
35.	杜方. 经导管主动脉瓣置换术后永久起搏器植入发生率及预测因子、预后分析. 浙江大学, 2019.
36.	Piazza N, de Jaegere P, Schultz C, et al. Anatomy of the aortic valvar complex and its implications for transcatheter implantation of the aortic valve. Circ Cardiovasc Interv, 2008, 1(1): 74-81.
37.	成泽怡, 郭应强. 经导管主动脉瓣置换术并发症的最新进展. 中国胸心血管外科临床杂志, 2019, 26(5): 494-498.
38.	Aktug O, Dohmen G, Brehmer K, et al. Incidence and predictors of left bundle branch block after transcatheter aortic valve implantation. Int J Cardiol, 2012, 160(1): 26-30.
39.	Hein-Rothweiler R, Jochheim D, Rizas K, et al. Aortic annulus to left coronary distance as a predictor for persistent left bundle branch block after TAVI. Catheter Cardiovasc Interv, 2017, 89(4): E162-E168.
40.	Urena M, Mok M, Serra V, et al. Predictive factors and long-term clinical consequences of persistent left bundle branch block following transcatheter aortic valve implantation with a balloon-expandable valve. J Am Coll Cardiol, 2012, 60(18): 1743-1752.
41.	Witt CM, Wu G, Yang D, et al. Outcomes with left bundle branch block and mildly to moderately reduced left ventricular function. JACC Heart Fail, 2016, 4(11): 897-903.
42.	郭帅, 张斌, 吴永健. 经导管主动脉瓣置换术的最新进展. 中国医刊, 2020, 55(1): 4-7.
43.	Liao YB, Zhao ZG, Wei X, et al. Transcatheter aortic valve implantation with the self-expandable venus a-valve and corevalve devices: Preliminary experiences in China. Catheter Cardiovasc Interv, 2017, 89(S1): 528-533.
44.	Fei X, Elhmidi Y, Zhang B, et al. Transapical transcatheter aortic valve implantation using a new TAVI system for high-risk patients with severe aortic stenosis. Heart Lung Circ, 2018, 27(6): e67-e69.
45.	Zhu D, Chen Y, Guo Y, et al. Transapical transcatheter aortic valve implantation using a new second-generation TAVI system—J-valve^TM for high-risk patients with aortic valve diseases: Initial results with 90-day follow-up. Int J Cardiol, 2015, 199: 155-162.
46.	潘佳君, 唐小军, 乔帆, 等. 经导管主动脉瓣置换术后心脏传导阻滞情况分析. 第二军医大学学报, 2019, 40(8): 902-908.

1. Kanwar A, Thaden JJ, Nkomo VT. Management of patients with aortic valve stenosis. Mayo Clin Proc, 2018, 93(4): 488-508.
2. Eveborn GW, Schirmer H, Heggelund G, et al. The evolving epidemiology of valvular aortic stenosis. Tromsø study. Heart, 2013, 99(6): 396-400.
3. 李伯慧, 何宇欣, 刘先宝, 等. 主动脉瓣钙化相关的经导管主动脉瓣置换术并发症的现状与进展. 心电与循环, 2020, 39(3): 304-309.
4. Iung B, Cachier A, Baron G, et al. Decision-making in elderly patients with severe aortic stenosis: Why are so many denied surgery? Eur Heart J, 2005, 26(24): 2714-2720.
5. 张倩, 王墨扬, 吴永健. 《经导管主动脉瓣置换术中国专家共识(2020更新版)》解读. 华西医学, 2021, 36(9): 1191-1195.
6. 施浩, 王首正, 谢涌泉. 未来已来: 经导管主动脉瓣置换术在中低危患者的临床应用现状和前景. 中国胸心血管外科临床杂志, 2019, 26(11): 1060-1062.
7. Massoullié G, Bordachar P, Ellenbogen KA, et al. New-onset left bundle branch block induced by transcutaneous aortic valve implantation. Am J Cardiol, 2016, 117(5): 867-873.
8. Auffret V, Puri R, Urena M, et al. Conduction disturbances after transcatheter aortic valve replacement: Current status and future perspectives. Circulation, 2017, 136(11): 1049-1069.
9. Jochheim D, Zadrozny M, Theiss H, et al. Aortic regurgitation with second versus third-generation balloon-expandable prostheses in patients undergoing transcatheter aortic valve implantation. EuroIntervention, 2015, 11(2): 214-220.
10. Auffret V, Martins RP, Daubert C, et al. Idiopathic/iatrogenic left bundle branch block-induced reversible left ventricle dysfunction: JACC state-of-the-art review. J Am Coll Cardiol, 2018, 72(24): 3177-3188.
11. Zannad F, Huvelle E, Dickstein K, et al. Left bundle branch block as a risk factor for progression to heart failure. Eur J Heart Fail, 2007, 9(1): 7-14.
12. Regueiro A, Abdul-Jawad Altisent O, Del Trigo M, et al. Impact of new-onset left bundle branch block and periprocedural permanent pacemaker implantation on clinical outcomes in patients undergoing transcatheter aortic valve replacement: A systematic review and meta-analysis. Circ Cardiovasc Interv, 2016, 9(5): e003635.
13. Faroux L, Chen S, Muntane-Carol G, et al. Clinical impact of conduction disturbances in transcatheter aortic valve replacement recipients: A systematic review and meta-analysis. Eur Heart J, 2020, 41(29): 2771-2781.
14. Søndergaard L, Steinbrüchel DA, Ihlemann N, et al. Two-year outcomes in patients with severe aortic valve stenosis randomized to transcatheter versus surgical aortic valve replacement: The all-comers nordic aortic valve intervention randomized clinical trial. Circ Cardiovasc Interv, 2016, 9(6): e003665.
15. Cota GF, de Sousa MR, Fereguetti TO, et al. Efficacy of anti-leishmania therapy in visceral leishmaniasis among HIV infected patients: A systematic review with indirect comparison. PLoS Negl Trop Dis, 2013, 7(5): e2195.
16. Testa L, Latib A, De Marco F, et al. Clinical impact of persistent left bundle-branch block after transcatheter aortic valve implantation with corevalve revalving system. Circulation, 2013, 127(12): 1300-1307.
17. Nazif TM, Williams MR, Hahn RT, et al. Clinical implications of new-onset left bundle branch block after transcatheter aortic valve replacement: Analysis of the partner experience. Eur Heart J, 2014, 35(24): 1599-1607.
18. Franzoni I, Latib A, Maisano F, et al. Comparison of incidence and predictors of left bundle branch block after transcatheter aortic valve implantation using the corevalve versus the edwards valve. Am J Cardiol, 2013, 112(4): 554-559.
19. Houthuizen P, van der Boon RM, Urena M, et al. Occurrence, fate and consequences of ventricular conduction abnormalities after transcatheter aortic valve implantation. EuroIntervention, 2014, 9(10): 1142-1150.
20. Akdemir B, Roukoz H. A single-centre cohort and short-term follow-up of patients who developed persistent new onset left bundle branch block after transcatheter aortic valve replacement. Acta Cardiol, 2020, 75(4): 360-365.
21. Sasaki K, Izumo M, Kuwata S, et al. Clinical impact of new-onset left bundle-branch block after transcatheter aortic valve implantation in the Japanese population —A single high-volume center experience. Circ J, 2020, 84(6): 1012-1019.
22. Hamandi M, Tabachnick D, Lanfear AT, et al. Effect of new and persistent left bundle branch block after transcatheter aortic valve replacement on long-term need for pacemaker implantation. Proc (Bayl Univ Med Cent), 2020, 33(2): 157-162.
23. Jørgensen TH, De Backer O, Gerds TA, et al. Mortality and heart failure hospitalization in patients with conduction abnormalities after transcatheter aortic valve replacement. JACC Cardiovasc Interv, 2019, 12(1): 52-61.
24. Houthuizen P, Van Garsse LA, Poels TT, et al. Left bundle-branch block induced by transcatheter aortic valve implantation increases risk of death. Circulation, 2012, 126(6): 720-728.
25. Schymik G, Tzamalis P, Bramlage P, et al. Clinical impact of a new left bundle branch block following TAVI implantation: 1-year results of the TAVI cohort. Clin Res Cardiol, 2015, 104(4): 351-362.
26. Urena M, Webb JG, Cheema A, et al. Impact of new-onset persistent left bundle branch block on late clinical outcomes in patients undergoing transcatheter aortic valve implantation with a balloon-expandable valve. JACC Cardiovasc Interv, 2014, 7(2): 128-136.
27. Carrabba N, Valenti R, Migliorini A, et al. Impact on left ventricular function and remodeling and on 1-year outcome in patients with left bundle branch block after transcatheter aortic valve implantation. Am J Cardiol, 2015, 116(1): 125-131.
28. Kessler M, Gonska B, Seeger J, et al. Long-term clinical outcome of persistent left bundle branch block after transfemoral aortic valve implantation. Catheter Cardiovasc Interv, 2019, 93(3): 538-544.
29. Chamandi C, Barbanti M, Munoz-Garcia A, et al. Long-term outcomes in patients with new-onset persistent left bundle branch block following TAVR. JACC Cardiovasc Interv, 2019, 12(12): 1175-1184.
30. Nazif TM, Chen S, George I, et al. New-onset left bundle branch block after transcatheter aortic valve replacement is associated with adverse long-term clinical outcomes in intermediate-risk patients: An analysis from the partner Ⅱ trial. Eur Heart J, 2019, 40(27): 2218-2227.
31. Eschalier R, Massoullié G, Nahli Y, et al. New-onset left bundle branch block after TAVI has a deleterious impact on left ventricular systolic function. Can J Cardiol, 2019, 35(10): 1386-1393.
32. López-Aguilera J, Segura Saint-Gerons JM, Mazuelos Bellido F, et al. Effect of new-onset left bundle branch block after transcatheter aortic valve implantation (corevalve) on mortality, frequency of re-hospitalization, and need for pacemaker. Am J Cardiol, 2016, 118(9): 1380-1385.
33. 王勇, 张辰, 刘婷, 等. 应用venus-a瓣膜行经导管主动脉瓣置换术后传导阻滞患者特征和心脏解剖结构分析. 华西医学, 2020, 35(9): 1044-1049.
34. Boerlage-Van Dijk K, Kooiman KM, Yong ZY, et al. Predictors and permanency of cardiac conduction disorders and necessity of pacing after transcatheter aortic valve implantation. Pacing Clin Electrophysiol, 2014, 37(11): 1520-1529.
35. 杜方. 经导管主动脉瓣置换术后永久起搏器植入发生率及预测因子、预后分析. 浙江大学, 2019.
36. Piazza N, de Jaegere P, Schultz C, et al. Anatomy of the aortic valvar complex and its implications for transcatheter implantation of the aortic valve. Circ Cardiovasc Interv, 2008, 1(1): 74-81.
37. 成泽怡, 郭应强. 经导管主动脉瓣置换术并发症的最新进展. 中国胸心血管外科临床杂志, 2019, 26(5): 494-498.
38. Aktug O, Dohmen G, Brehmer K, et al. Incidence and predictors of left bundle branch block after transcatheter aortic valve implantation. Int J Cardiol, 2012, 160(1): 26-30.
39. Hein-Rothweiler R, Jochheim D, Rizas K, et al. Aortic annulus to left coronary distance as a predictor for persistent left bundle branch block after TAVI. Catheter Cardiovasc Interv, 2017, 89(4): E162-E168.
40. Urena M, Mok M, Serra V, et al. Predictive factors and long-term clinical consequences of persistent left bundle branch block following transcatheter aortic valve implantation with a balloon-expandable valve. J Am Coll Cardiol, 2012, 60(18): 1743-1752.
41. Witt CM, Wu G, Yang D, et al. Outcomes with left bundle branch block and mildly to moderately reduced left ventricular function. JACC Heart Fail, 2016, 4(11): 897-903.
42. 郭帅, 张斌, 吴永健. 经导管主动脉瓣置换术的最新进展. 中国医刊, 2020, 55(1): 4-7.
43. Liao YB, Zhao ZG, Wei X, et al. Transcatheter aortic valve implantation with the self-expandable venus a-valve and corevalve devices: Preliminary experiences in China. Catheter Cardiovasc Interv, 2017, 89(S1): 528-533.
44. Fei X, Elhmidi Y, Zhang B, et al. Transapical transcatheter aortic valve implantation using a new TAVI system for high-risk patients with severe aortic stenosis. Heart Lung Circ, 2018, 27(6): e67-e69.
45. Zhu D, Chen Y, Guo Y, et al. Transapical transcatheter aortic valve implantation using a new second-generation TAVI system—J-valve^TM for high-risk patients with aortic valve diseases: Initial results with 90-day follow-up. Int J Cardiol, 2015, 199: 155-162.
46. 潘佳君, 唐小军, 乔帆, 等. 经导管主动脉瓣置换术后心脏传导阻滞情况分析. 第二军医大学学报, 2019, 40(8): 902-908.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Prognosis of new-onset left bundle branch block after transcatheter aortic valve replacement in patients with aortic stenosis: A systematic review and meta-analysis

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