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The impact of trans-catheter aortic valve replacement induced left-bundle branch block on cardiac reverse remodeling

Laura E Dobson1, Tarique A Musa1, Akhlaque Uddin1

  • 1Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Clarendon Way, Leeds, LS2 9JT, UK.

Journal of Cardiovascular Magnetic Resonance : Official Journal of the Society for Cardiovascular Magnetic Resonance
|February 23, 2017
PubMed

Insights

Trans-catheter aortic valve replacement (TAVR) can cause left bundle branch block (LBBB), leading to poorer cardiac reverse remodeling. Preventing TAVR-induced LBBB is crucial for better patient outcomes.

Area of Science:

  • Cardiology
  • Cardiac Electrophysiology
  • Cardiovascular Imaging

Background:

  • Left bundle branch block (LBBB) is a common complication after trans-catheter aortic valve replacement (TAVR).
  • The association between TAVR-induced LBBB and long-term mortality, particularly concerning cardiac reverse remodeling, remains unclear.
  • This study investigates the impact of TAVR-induced LBBB on cardiac reverse remodeling.

Purpose of the Study:

  • To determine the effect of new-onset left bundle branch block (LBBB) following trans-catheter aortic valve replacement (TAVR) on cardiac reverse remodeling.
  • To compare cardiac remodeling parameters in patients who developed LBBB post-TAVR versus those with a narrow QRS.
  • To assess the relationship between QRS duration and changes in left ventricular function and strain.

Main Methods:

  • 48 patients with severe aortic stenosis undergoing TAVR were analyzed.
  • 24 patients with new LBBB post-TAVR (LBBB-T) were matched with 24 patients with a narrow post-procedure QRS (nQRS).
  • Cardiovascular magnetic resonance (CMR) was used to assess left ventricular (LV) size, ejection fraction (LVEF), global longitudinal strain (GLS), and ventricular dyssynchrony before and 6 months after TAVR.

Main Results:

  • Patients with TAVR-induced LBBB showed significantly increased QRS duration and developed inter- and intra-ventricular dyssynchrony compared to the nQRS group.
  • The LBBB-T group exhibited less favorable changes in indexed LV end-systolic volume (LVESVi), LVEF, and GLS at 6 months post-TAVR.
  • Post-procedure QRS duration was a significant independent predictor of changes in LVEF and GLS at 6-month follow-up.

Conclusions:

  • Trans-catheter aortic valve replacement-induced left bundle branch block is associated with impaired cardiac reverse remodeling in the medium term.
  • Preventive strategies against TAVR-induced LBBB should be prioritized, especially with TAVR expanding to younger, lower-risk populations.
  • Further research is warranted to elucidate the mechanisms linking TAVR-LBBB to adverse remodeling and long-term outcomes.
Abstract

Keywords:
Aortic valve stenosisCardiovascular magnetic resonanceLeft bundle branch blockTrans-catheter aortic valve implantationVentricular ejection fractionVentricular remodeling

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