The Prognostic Relevance of a New Bundle Branch Block After Transcatheter Aortic Valve Implantation: A Systematic Review and Meta-Analysis
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Bibliographic record
Abstract
<h2>Abstract</h2><h3>Background</h3> 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. <h3>Methods</h3> 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. <h3>Results</h3> 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<sup>2</sup> = 49%, <i>p</i> < 0.01), cardiovascular mortality (RR 1.34 [95% CI 1.02-1.75], I<sup>2</sup> = 60%, <i>p</i> = 0.02), heart failure-related rehospitalization (RR 1.56 [95% CI 1.31-1.84], I<sup>2</sup> = 47%, <i>p</i> < 0.01), and permanent pacemaker implantation at 1 year (RR 3.05 [95% CI 2.39-3.89], I<sup>2</sup> = 14%, <i>p</i> < 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<sup>2</sup> = 93%, <i>p</i> = 0.11), however increased the risk of pacemaker implantation at 1 year (RR 4.68 [95% CI 3.60-6.08], I<sup>2</sup> = 67%, <i>p</i> < 0.01). <h3>Conclusions</h3> 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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Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.006 | 0.017 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 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 it