Impact of post-operative left bundle branch block on left ventricular remodeling following transapical beating-heart septal myectomy

Xueqing Cheng; Jeffrey B Geske; Wei Zhou; Ying Zhu; Jing Fang; Yue Chen; Jie Tian; Shiliang Liu; Hui Wang; Youbin Deng; Xiang Wei; Yani Liu

doi:10.1016/j.jtcvs.2025.06.022

Impact of post-operative left bundle branch block on left ventricular remodeling following transapical beating-heart septal myectomy

J Thorac Cardiovasc Surg. 2025 Jun 25:S0022-5223(25)00542-2. doi: 10.1016/j.jtcvs.2025.06.022. Online ahead of print.

Authors

Xueqing Cheng¹, Jeffrey B Geske², Wei Zhou¹, Ying Zhu¹, Jing Fang³, Yue Chen³, Jie Tian¹, Shiliang Liu¹, Hui Wang¹, Youbin Deng⁴, Xiang Wei⁵, Yani Liu⁶

Affiliations

¹ Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; Clinical Research Center for Hypertrophic Cardiomyopathy in Hubei Province.
² Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.
³ Clinical Research Center for Hypertrophic Cardiomyopathy in Hubei Province; Department of Cardiovascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
⁴ Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
⁵ Clinical Research Center for Hypertrophic Cardiomyopathy in Hubei Province; Department of Cardiovascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China. Electronic address: xiangwei@tjh.tjmu.edu.cn.
⁶ Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; Clinical Research Center for Hypertrophic Cardiomyopathy in Hubei Province. Electronic address: yani.liu@163.com.

PMID: 40578548
DOI: 10.1016/j.jtcvs.2025.06.022

Abstract

Objective: (s): To evaluate the incidence of post-operative Left bundle branch block (LBBB) and its impact on left ventricular (LV) remodeling in patients with obstructive hypertrophic cardiomyopathy (oHCM) following transapical beating-heart septal myectomy (TA-BSM).

Methods: This study included 286 patients with oHCM who underwent TA-BSM without preoperative conduction abnormalities or permanent pacemaker implantation. Clinical data, laboratory tests, electrocardiography, and echocardiography were compared between post-operative new-onset LBBB and non-LBBB groups, both pre- and 6-12 months post-surgery. The effect of post-operative LBBB on LV remodeling was evaluated using mid septal strain-based staging classification. Multivariate logistic regression based on minimized Akaike information criterion was performed to detect the predictors for the adverse LV remodeling after TA-BSM. A composite outcome of heart failure hospitalization, new-onset atrial fibrillation, stroke, thrombosis, permanent pacemaker implantation, and all-cause mortality was assessed.

Results: Post-operatively, 180 (63%) developed persistent new-onset LBBB compared to 106 (37%) who did not. Compared to the non-LBBB group, the new-onset LBBB group exhibited longer QRS duration and peak strain dispersion after TA-BSM. However, GLS was not different between the two groups post-operatively (P =0.146). Septal strain-based staging in the new-onset LBBB group showed 14% normal, 60% LBBB-1, 16% LBBB-2, and 10% LBBB-3. Stage LBBB-3 had worse GLS and a more pronounced delay in electrical activity post-TA-BSM. Stage LBBB-3 was associated with a higher incidence of heart failure hospitalization during a median follow-up of 22 (interquartile range: 18-25) months. Preoperative GLS and QRS duration were independent predictors of stage LBBB-3.

Conclusion: Although 63% of oHCM patients develop LBBB after TA-BSM, the effects on LV mechanical activity mainly fall into stages LBBB-1 and LBBB-2, with most new-onset LBBB patients showing significant LV reverse remodeling similar to those without LBBB. Preoperative poor GLS and prolonged QRS duration predict stage LBBB-3 and adverse LV remodeling post-TA-BSM.

Keywords: Left bundle branch block; Reverse remodeling; Strain pattern analysis; Transapical beating-heart septal myectomy.