The Prognostic Relevance of a New Bundle Branch Block After Transcatheter Aortic Valve Implantation: A Systematic Review and Meta-Analysis

Abstract

Background

Interference with the cardiac conduction system is common after transcatheter aortic valve implantation (TAVI), manifesting as atrioventricular block, or more commonly, new-onset persistent left bundle branch block (NOP-LBBB). Bundle branch block results in ventricular dyssynchrony and reduced cardiac output and may be associated with a poorer prognosis. This systematic review and meta-analysis evaluates the prognostic impact of a left or right bundle branch block after TAVI.

Methods

A systematic review was performed of the following online databases: PubMed, Medline, Scopus, and Web of Science, including English language studies from 2014 to 2024. Two separate searches for conducted for NOP-LBBB and new-onset persistent right bundle branch block (NOP-RBBB). The Newcastle-Ottawa Scale was used to evaluate risk of bias.

Results

Twenty-three studies totaling 18875 patients were included for NOP-LBBB, whilst 5 studies with a total of 3525 patients were included for NOP-RBBB. NOP-LBBB was associated with higher all-cause mortality at 1 year (risk ratio [RR] 1.41 [95% CI 1.12-1.78], I² = 49%, p < 0.01), cardiovascular mortality (RR 1.34 [95% CI 1.02-1.75], I² = 60%, p = 0.02), heart failure-related rehospitalization (RR 1.56 [95% CI 1.31-1.84], I² = 47%, p < 0.01), and permanent pacemaker implantation at 1 year (RR 3.05 [95% CI 2.39-3.89], I² = 14%, p < 0.01). NOP-RBBB was not associated with higher all-cause mortality at 1 year (RR 1.74 [95% CI 0.88-3.46], I² = 93%, p = 0.11), however increased the risk of pacemaker implantation at 1 year (RR 4.68 [95% CI 3.60-6.08], I² = 67%, p < 0.01).

Conclusions

NOP-LBBB is associated with higher mortality and heart failure rehospitalization after TAVI, whilst both NOP-LBBB and NOP-RBBB increase the risk of permanent pacemaker implantation at 1 year after TAVI.