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Effects of Left Bundle Branch Block and Pacemaker Implantation on Left Ventricular Systolic Function After

Giulia Dolci1, Gurpreet K Singh2, Xu Wang2

  • 1Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands; Department of Cardio-Thoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands.

The American Journal of Cardiology
|July 17, 2022
PubMed

Insights

Permanent pacemaker implantation (PPI) and new left bundle branch block (LBBB) after transcatheter aortic valve implantation (TAVI) can affect left ventricular ejection fraction (LVEF). LVEF improved post-TAVI, but new LBBB and high pacing burden may hinder recovery.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiac Electrophysiology

Background:

  • Transcatheter aortic valve implantation (TAVI) is a common procedure for aortic stenosis.
  • The frequency and impact of permanent pacemaker implantation (PPI) and new left bundle branch block (LBBB) after TAVI on left ventricular ejection fraction (LVEF) are not fully understood.
  • Understanding these factors is crucial for optimizing post-TAVI patient outcomes.

Purpose of the Study:

  • To evaluate the incidence of PPI and new-onset LBBB following TAVI.
  • To assess the impact of PPI and new-onset LBBB on LVEF at 6-month follow-up.
  • To analyze the influence of right ventricular (RV) pacing burden on LVEF changes after TAVI.

Main Methods:

  • Retrospective analysis of 377 patients undergoing TAVI.
  • Electrocardiograms collected at multiple time points; LVEF measured at baseline and 6 months post-TAVI.
  • Patients categorized based on LBBB occurrence, PPI requirement, or absence of conduction abnormalities; RV pacing burden analyzed in PPI patients.

Main Results:

  • New-onset LBBB occurred in 24% and PPI was required in 15% of patients.
  • Overall LVEF significantly increased post-TAVI, particularly in patients without new conduction abnormalities.
  • Patients with baseline LVEF ≤50% showed LVEF recovery, less pronounced with new LBBB but present with PPI regardless of pacing burden; pressure overload relief counteracted negative effects in this group.

Conclusions:

  • New-onset LBBB after TAVI can impede LVEF recovery.
  • LVEF improves post-TAVI, especially in patients with baseline LVEF ≤50%, with PPI not hindering this improvement.
  • Pressure overload relief is a significant factor in LVEF recovery among patients with baseline LVEF ≤50%, mitigating the impact of LBBB or RV pacing.

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