Long-Term Outcomes in Patients With New-Onset Left Bundle Branch Block Following TAVR

New-onset persistent left bundle branch block (NOP-LBBB) is a frequent conduction disturbance following transcatheter aortic valve replacement (TAVR), yet its long-term prognostic significance remains uncertain.

The aim of this study was to assess the impact of NOP-LBBB on long-term (up to 10 years) clinical and echocardiographic outcomes after TAVR.

A total of 1,052 consecutive patients without preprocedural LBBB or permanent pacemaker implantation were included. NOP-LBBB was defined as new LBBB following TAVR persisting at discharge. Clinical and echocardiographic outcomes were prospectively collected in a dedicated database, and the median follow-up duration was 5 years (Q1-Q3: 3-6 years).

NOP-LBBB occurred in 312 patients (29.6%). Compared with patients without NOP-LBBB, those with NOP-LBBB had a higher incidence of the composite endpoint of cardiovascular mortality or heart failure hospitalization (37.5% vs 31.5%; adjusted HR [aHR]: 1.37; 95% CI: 1.09-1.73; P = 0.007). This difference was driven primarily by an increased cardiovascular mortality risk (30.5% vs 23.8%; aHR: 1.46; 95% CI: 1.12-1.89; P = 0.004), including a higher rate of sudden death in the NOP-LBBB group (4.2% vs 1.5%, aHR: 3.52; 95% CI: 1.53-8.14; P = 0.003). A higher incidence of left ventricular ejection fraction decline (≥10%) was observed in the NOP-LBBB group (P = 0.025) with no differences in heart failure hospitalization between groups (P = 0.243).

NOP-LBBB following TAVR was associated with adverse long-term outcomes, including cardiovascular mortality, sudden death, and progressive left ventricular dysfunction. These findings underscore the need for tailored follow-up and risk stratification in this high-risk subgroup.