BACKGROUND: New-onset persistent left bundle branch block (NOP-LBBB) at discharge after transcatheter aortic valve replacement (TAVR) is frequent, but its association with death and hospitalization for heart failure (HHF) remains unclear. OBJECTIVE: We aimed to assess the association of LBBB persistence or resolution after discharge and of permanent pacemaker (PPM) implantation before discharge with these outcomes. METHODS: We analyzed consecutive patients undergoing TAVR at Nancy University Hospital from 2009 to 2021 with NOP-LBBB at discharge and available 1-year follow-up. We assessed the association of LBBB persistence (LBBB+) or resolution (LBBB-) at 3 months and in-hospital PPM implantation (PPM+) or absence (PPM-) with the 1-year risk of the composite outcome of mortality or HHF. RESULTS: Of 1646 TAVR patients, 287 (17.4%) had NOP-LBBB, with complete follow-up data available for 234 patients. Of them, 73 patients (31.2%) required in-hospital PPM implantation, 142 patients (60.7%) experienced LBBB persistence at 3-month follow-up, and 45 (19.2%) had both. The 1-year mortality or HHF rate was 6.3% (PPM-/LBBB-), 10.7% (PPM+/LBBB-), 20.6% (PPM-/LBBB+), and 22.2% (PPM+/LBBB+). LBBB persistence was significantly associated with the composite outcome irrespective of PPM implantation (adjusted hazard ratio [aHR] compared with PPM-/LBBB-: aHR for PPM-/LBBB+, 4.91 [1.64-14.64
P = .004]
aHR for PPM+/LBBB+, 4.58 [1.43-14.68
P = .010]), whereas PPM implantation with LBBB- was not (P = .29). This association was mainly driven by HHF (aHR for PPM-/LBBB+, 8.36 [1.90-36.83
P = .005]
aHR for PPM+/LBBB+, 8.36 [1.80-38.89
P = .007]). CONCLUSION: The persistence of LBBB beyond discharge, rather than in-hospital PPM implantation, was associated with a higher risk of 1-year mortality or HHF in patients with NOP-LBBB at discharge after TAVR. Assessing postdischarge LBBB persistence may improve prognostic accuracy.