Clinical outcomes of early discharge in TAVI patients with new-onset LBBB

Transcatheter Aortic Valve Implantation (TAVI) has become the standard therapeutic option for an increasing number of patients with severe aortic stenosis. Despite its minimally invasive nature, conduction disturbances remain a frequent post-procedural complication, often leading to the need for permanent pacemaker (PPM) implantation. Among these, the development of new-onset left bundle branch block (LBBB) is particularly concerning, as it has been associated with adverse outcomes during follow-up. Consequently, clinicians may hesitate to discharge such patients early.

We performed a retrospective analysis of prospectively collected data from all consecutive TAVI procedures conducted at a single center, with emphasis on conduction abnormalities and pacemaker implantation. Patients who died during the index hospitalization, had a prior PPM, or required PPM implantation before discharge were excluded. The study compared patients who developed new-onset LBBB after TAVI with those who did not. The primary endpoint was rehospitalization leading to PPM implantation at 1 and 6 months of follow-up. Secondary endpoints included hospital length of stay.

Among 300 patients undergoing TAVI, 33 (11%) developed new-onset LBBB, while 190 were included in the control group. Baseline characteristics were comparable between groups. At 1-month follow-up, readmission for PPM implantation occurred in 1 patient (3.0%) with new-onset LBBB and in 3 patients (1.1%) in the control group (p = 0.383). At 6 months, PPM implantation was required in 2 (6.1%) and 3 (1.6%) patients, respectively (p = 0.159). Median hospital stay was similar in both groups—3.0 days (IQR 3) for new-onset LBBB vs. 3.0 days (IQR 4) for controls (p = 0.546).

In this cohort, early discharge after TAVI was performed safely in patients who developed new-onset LBBB. Hospitalization duration did not differ significantly, and short-term readmission rates for PPM implantation were comparable to those without LBBB. These findings suggest that early discharge strategies can be safely extended to TAVI patients with new-onset LBBB, provided appropriate monitoring protocols are in place.