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Updated: Feb 4, 2026
Upper-extremity Approach for Secondary Access in Transfemoral Transcatheter Aortic Valve Implantation
Published on: August 8, 2025
Long-term clinical outcome of persistent left bundle branch block after transfemoral aortic valve implantation
Mirjam Keßler1, Birgid Gonska1, Julia Seeger1
1Department of Internal Medicine II, University of Ulm, Ulm, Germany.
Insights
Persistent left bundle-branch block (pLBBB) after TAVI is linked to valve type and implantation depth, increasing pacemaker needs. However, pLBBB does not impact 2-year mortality or heart failure rehospitalization rates.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Electrophysiology
Background:
- New-onset persistent left bundle-branch block (pLBBB) is a frequent complication following transcatheter aortic valve implantation (TAVI).
- The long-term clinical impact of pLBBB after TAVI requires further investigation.
Purpose of the Study:
- To determine the impact of new-onset persistent left bundle-branch block (pLBBB) on clinical outcomes up to 2 years post-TAVI.
- To identify predictors for the development of pLBBB after TAVI.
Main Methods:
- Analysis of 707 patients undergoing TAVI, divided into groups with and without pLBBB at discharge.
- Propensity-score matching to compare baseline characteristics, procedural data, and clinical outcomes.
- Assessment of valve types (balloon-expandable, mechanically expandable, self-expandable) and implantation depth as potential factors.
Main Results:
- 47.5% of patients developed new-onset pLBBB post-TAVI.
- Mechanically expandable valves (54.2%) were associated with higher pLBBB rates compared to balloon-expandable valves (39.8%).
- Deeper implantation depth and mechanically expandable valves were independent predictors of pLBBB, which was also linked to increased permanent pacemaker implantation (40.9% vs. 15.9%).
Conclusions:
- The occurrence of pLBBB after TAVI is associated with specific valve types and implantation depth.
- pLBBB necessitates higher rates of permanent pacemaker implantation.
- Importantly, pLBBB did not significantly affect 2-year mortality or rehospitalization rates due to heart failure.
Objective:
The impact of persistent left bundle-branch block (pLBBB) on long-term clinical outcome remains to be determined.
Background:
New-onset of pLBBB occurs frequently after transfemoral aortic valve implantation (TAVI).
Methods:
Seven hundred and seven consecutive patients who underwent TAVI were analyzed for baseline and procedural characteristics and clinical outcome in an up to 2-year follow-up. Patients were divided into either a group with pLBBB until hospital discharge or a group without LBBB. We performed propensity-score matching and analyzed baseline characteristics, procedural data and clinical outcome of both groups. Patients received balloon-expandable valves in 56.4%, mechanically expandable valves in 37.5%, and self-expandable valves in 6.3%.
Results:
A new-onset, pLBBB was observed in 47.5% of patients after TAVI. The implantation of a mechanically expandable valve was associated with higher rate of pLBBB (54.2% vs. 20.8%, P < 0.001), whereas implantation of a balloon-expandable valve was associated with lower incidence of pLBBB (39.8% vs. 73.1%, P < 0.001). Deeper ventricular implantation at left-coronary side led to higher rates of pLBBB (7.5 ± 2.5 vs. 6.7 ± 2.6 mm, P < 0.001). The occurrence of pLBBB was associated with higher rates of permanent pacemaker implantation (40.9% vs. 15.9%, P < 0.001). By multivariate analysis, implantation of a mechanically expandable valve (Boston Scientific Lotus valve) was identified as independent predictor of occurrence of pLBBB (odds ratio 4.7, confidence interval 3.2-7.0, P < 0.001). In the 2-year follow-up, there were no significant differences between "pLBBB" and "no LBBB"-groups regarding mortality and rehospitalization due to heart failure.
Conclusions:
The occurrence of pLBBB is associated with the choice of valve type and implantation depth and requires significantly higher rates of permanent pacemaker implantations. Importantly, there are no differences in the 2-year follow-up regarding mortality and rehospitalization due to heart failure.
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