The Prognostic Relevance of a New Bundle Branch Block After Transcatheter Aortic Valve Implantation: A Systematic Review and Meta-Analysis
Bibliographic record
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], I 2 = 49%, p < 0.01), cardiovascular mortality (RR 1.34 [95% CI 1.02-1.75], I 2 = 60%, p = 0.02), heart failure-related rehospitalization (RR 1.56 [95% CI 1.31-1.84], I 2 = 47%, p < 0.01), and permanent pacemaker implantation at 1 year (RR 3.05 [95% CI 2.39-3.89], I 2 = 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], I 2 = 93%, p = 0.11), however increased the risk of pacemaker implantation at 1 year (RR 4.68 [95% CI 3.60-6.08], I 2 = 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.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.008 | 0.021 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.013 | 0.027 |
| Bibliometrics | 0.005 | 0.007 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.001 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".