TY - JOUR
T1 - Left Bundle-Branch Block Induced by Transcatheter Aortic Valve Implantation Increases Risk of Death
AU - Houthuizen, Patrick
AU - van Garsse, Leen A. F. M.
AU - Poels, Thomas T.
AU - de Jaegere, Peter
AU - van der Boon, Robert M. A.
AU - Swinkels, Ben M.
AU - ten Berg, Jurriën M.
AU - van der Kley, Frank
AU - Schalij, Martin J.
AU - Baan, Jan
AU - Cocchieri, Ricardo
AU - Brueren, Guus R. G.
AU - van Straten, Albert H. M.
AU - den Heijer, Peter
AU - Bentala, Mohamed
AU - van Ommen, Vincent
AU - Kluin, Jolanda
AU - Stella, Pieter R.
AU - Prins, Martin H.
AU - Maessen, Jos G.
AU - Prinzen, Frits W.
PY - 2012
Y1 - 2012
N2 - Background-Transcatheter aortic valve implantation (TAVI) is a novel therapy for treatment of severe aortic stenosis. Although 30% to 50% of patients develop new left bundle-branch block (LBBB), its effect on clinical outcome is unclear. Methods and Results-Data were collected in a multicenter registry encompassing TAVI patients from 2005 until 2010. The all-cause mortality rate at follow-up was compared between patients who did not develop new LBBB. Of 679 patients analyzed, 387 (57.0%) underwent TAVI wih the Medtronic CoreValve System and 292 (43.0%) with the Edwards SAPIEN valve. A total of 233 patients (34.3%) developed new LBBB. Median follow-up was 449.5 (interquartiel range, 174-834) days in patients with and 450 (interquartile range, 253-725) days in patients without LBBB (P=0.90). All cause mortality was 37.8% (n=88) in patients with LBBB and 24.0% (n=107) patients without LBBB (P=0.002). By multivariate regression analysis, indepedent predictors of all-cause mortality were TAVI-induced LBBB (hazard ratio [HR], 1.54; condifence interval [CI], 1.12-2.10), chronic obstructive lung disease (HR, 1.56; CI, 1.15-2.10), female sex (HR, 1.39; CI, 1.04-1.85), left ventricular ejection fraction <= 50% (HR, 1.38; CI, 1.02-1.86), and baseline creatinine (HR, 1.32; CI, 1.19-1.43). LBBB was more frequent after implantation of the Medtronic Core Valve System than after Edwards SAPIEN implantation (51.1% and 12.0%, respectively; P <0.001), but device type did not influence the mortality risk of TAVI-induced LBBB. Conclusions-All-cause mortality after TAVI is higher in patients who develop LBBB than in patients who do not. TAVI-induced LBBB is an independent predictor of mortality. (Circulation. 2012;126:720-728.)
AB - Background-Transcatheter aortic valve implantation (TAVI) is a novel therapy for treatment of severe aortic stenosis. Although 30% to 50% of patients develop new left bundle-branch block (LBBB), its effect on clinical outcome is unclear. Methods and Results-Data were collected in a multicenter registry encompassing TAVI patients from 2005 until 2010. The all-cause mortality rate at follow-up was compared between patients who did not develop new LBBB. Of 679 patients analyzed, 387 (57.0%) underwent TAVI wih the Medtronic CoreValve System and 292 (43.0%) with the Edwards SAPIEN valve. A total of 233 patients (34.3%) developed new LBBB. Median follow-up was 449.5 (interquartiel range, 174-834) days in patients with and 450 (interquartile range, 253-725) days in patients without LBBB (P=0.90). All cause mortality was 37.8% (n=88) in patients with LBBB and 24.0% (n=107) patients without LBBB (P=0.002). By multivariate regression analysis, indepedent predictors of all-cause mortality were TAVI-induced LBBB (hazard ratio [HR], 1.54; condifence interval [CI], 1.12-2.10), chronic obstructive lung disease (HR, 1.56; CI, 1.15-2.10), female sex (HR, 1.39; CI, 1.04-1.85), left ventricular ejection fraction <= 50% (HR, 1.38; CI, 1.02-1.86), and baseline creatinine (HR, 1.32; CI, 1.19-1.43). LBBB was more frequent after implantation of the Medtronic Core Valve System than after Edwards SAPIEN implantation (51.1% and 12.0%, respectively; P <0.001), but device type did not influence the mortality risk of TAVI-induced LBBB. Conclusions-All-cause mortality after TAVI is higher in patients who develop LBBB than in patients who do not. TAVI-induced LBBB is an independent predictor of mortality. (Circulation. 2012;126:720-728.)
U2 - https://doi.org/10.1161/CIRCULATIONAHA.112.101055
DO - https://doi.org/10.1161/CIRCULATIONAHA.112.101055
M3 - Article
C2 - 22791865
SN - 0009-7322
VL - 126
SP - 720
EP - 728
JO - Circulation
JF - Circulation
IS - 6
ER -