Mortality and Heart Failure Hospitalization in Patients With Conduction Abnormalities After Transcatheter Aortic Valve Replacement

Troels H Jørgensen; Ole De Backer; Thomas A Gerds; Gintautas Bieliauskas; Jesper H Svendsen; Lars Søndergaard

doi:10.1016/j.jcin.2018.10.053

Mortality and Heart Failure Hospitalization in Patients With Conduction Abnormalities After Transcatheter Aortic Valve Replacement

JACC Cardiovasc Interv. 2019 Jan 14;12(1):52-61. doi: 10.1016/j.jcin.2018.10.053.

Authors

Troels H Jørgensen¹, Ole De Backer², Thomas A Gerds³, Gintautas Bieliauskas², Jesper H Svendsen⁴, Lars Søndergaard⁴

Affiliations

¹ Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark. Electronic address: troels.hoejsgaard.joergensen@regionh.dk.
² Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
³ Section of Biostatistics, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
⁴ Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.

PMID: 30621978
DOI: 10.1016/j.jcin.2018.10.053

Abstract

Objectives: The aim of this study was to assess mortality and rehospitalization in patients with new bundle branch block (BBB) and/or permanent pacemaker (PPM) after transcatheter aortic valve replacement (TAVR).

Background: Previous studies have provided inconsistent results on the clinical impact of new BBB or new PPM after TAVR.

Methods: A total of 816 consecutive patients without pre-procedural BBB or PPM undergoing TAVR between 2007 and 2017 were followed for 5 years or until data extraction in September 2017. Data on vital status and hospitalization were obtained through national registries.

Results: Within 30 days post-TAVR, new BBB without PPM and new PPM occurred in 247 (30.3%) and 132 (16.2%) patients, respectively, leaving 437 patients (53.6%) without conduction abnormalities. Median follow-up was 2.5 years (interquartile range: 1.0 to 4.9 years). One-year all-cause mortality was increased for new BBB (hazard ratio [HR]: 2.80; 95% confidence interval [CI]: 1.18 to 3.67) but not for new PPM (HR: 1.64; 95% CI: 0.72 to 3.74) compared with patients with no conduction abnormalities. The risk for late all-cause mortality (≥1 year after TAVR) was higher both for patients with new BBB (HR: 1.79; 95% CI: 1.24 to 2.59) and for those with new PPM (HR: 1.58; 95% CI: 1.01 to 2.46) compared with patients with no conduction abnormalities. Patients with new BBB (HR: 1.47; 95% CI: 1.02 to 2.12) and new PPM (HR: 1.66; 95% CI: 1.09 to 2.54) had a higher risk for heart failure hospitalization and reduced left ventricular ejection fraction (p < 0.0001 for both groups) during follow-up.

Conclusions: New BBB and new PPM developed frequently after TAVR. New BBB was associated with increased early and late all-cause mortality, whereas new PPM was associated with late all-cause mortality. Furthermore, both new BBB and new PPM increased the risk for heart failure hospitalizations.

Keywords: bundle branch block; conduction abnormality; pacemaker; transcatheter aortic valve replacement.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Aged, 80 and over
Aortic Valve / physiopathology
Aortic Valve / surgery*
Bundle-Branch Block / mortality*
Bundle-Branch Block / physiopathology
Bundle-Branch Block / therapy
Cardiac Pacing, Artificial
Cause of Death
Denmark / epidemiology
Female
Heart Failure / mortality*
Heart Failure / physiopathology
Heart Failure / therapy
Humans
Incidence
Male
Patient Readmission*
Prospective Studies
Registries
Risk Assessment
Risk Factors
Stroke Volume
Time Factors
Transcatheter Aortic Valve Replacement / adverse effects
Transcatheter Aortic Valve Replacement / mortality*
Treatment Outcome
Ventricular Function, Left