Impact of persistent left bundle branch block on ventricular function and clinical outcomes after transcatheter aortic valve implantation: a systematic review and meta-analysis

Abstract

Abstract Background New-onset persistent left bundle branch block (NOP-LBBB) is a frequent complication after transcatheter aortic valve implantation (TAVI), but its long-term prognostic impact remains controversial. This meta-analysis aimed to evaluate the impact of NOP-LBBB on changes in left ventricular ejection fraction (LVEF) and clinical outcomes after TAVI. Methods PubMed, Embase, and Cochrane Library were searched through May 2026 for studies comparing outcomes between patients with and without NOP-LBBB after TAVI. Random-effects models were used to calculate pooled mean differences (MD) for continuous outcomes and risk ratios (RR) for binary endpoints, with 95% confidence intervals (CIs). Results Thirty observational studies comprising 223,419 patients were included (37,856 with NOP-LBBB). NOP-LBBB was associated with a significant reduction in LVEF (MD, − 4.65%; 95% CI, − 6.03 to − 3.27), a higher risk of all-cause mortality (RR, 1.19; 95% CI, 1.05 to 1.35), heart failure hospitalization (RR, 1.48; 95% CI, 1.10 to 1.98), and permanent pacemaker implantation (RR, 2.24; 95% CI, 1.75 to 2.86). No significant difference was observed in cardiovascular mortality (RR, 1.29; 95% CI, 0.93 to 1.81). Conclusions NOP-LBBB after TAVI was associated with impaired LVEF recovery, a modest increase in all-cause mortality, and higher rates of HF hospitalization and permanent pacemaker implantation. The association with all-cause mortality remained statistically significant when restricted to studies at moderate risk of bias (RR, 1.23; 95% CI, 1.02 to 1.49) and after exclusion of the large registry cohort (RR, 1.19; 95% CI, 1.03 to 1.36); the HF hospitalization association remained statistically significant, albeit borderline, in the moderate risk-of-bias analysis (RR, 1.56; 95% CI, 1.01 to 2.42). Given the observational design of the included studies and the low-to-very-low certainty of the evidence, these findings should be regarded as hypothesis-generating and warrant confirmation in prospective studies.