{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T21:53:04Z","timestamp":1791237184224,"version":"4.1.0"},"reference-count":23,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T00:00:00Z","timestamp":1778112000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Catholic Medical Center Research Foundation"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background\/Objectives: Left bundle branch block (LBBB) remains a common complication after transcatheter aortic valve replacement (TAVR) and is associated with adverse clinical outcomes. However, accurate prediction of LBBB remains challenging due to the complex interactions among the anatomical, procedural, and clinical factors. This study aimed to develop a machine learning (ML)-based framework to predict LBBB and identify relevant contributing features. Methods: In this multicenter retrospective study, we analyzed 242 patients undergoing TAVR across three institutions. A machine learning framework incorporating transformer-based feature selection and conventional classifiers was developed. Model performance was evaluated using accuracy, precision, recall, F1-score, and area under the receiver operating characteristic curve (AUC). Internal validation was performed using bootstrap resampling. Results: The gradient boosting model using ML-derived features demonstrated the most balanced performance, achieving an accuracy of 78.05% and an F1-score of 50.46%, with modest discrimination (AUC 0.61). The ML-based approach identified clinically relevant features, including coronary height, left ventricular outflow tract\/annulus ratio, and prosthetic valve size, as well as additional variables not emphasized in conventional analyses. Conclusions: ML-based feature selection can capture complex feature interactions beyond traditional statistical approaches and provide clinically meaningful insights into risk stratification for LBBB after TAVR. Although predictive performance was modest, this approach highlights the potential of ML for improved risk stratification and individualized procedural planning. Further large-scale external validation is warranted.<\/jats:p>","DOI":"10.3390\/diagnostics16101422","type":"journal-article","created":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T12:15:07Z","timestamp":1778156107000},"page":"1422","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["A Transformer-Based Machine Learning Framework for Risk Stratification of Left Bundle Branch Block After Transcatheter Aortic Valve Replacement"],"prefix":"10.3390","volume":"16","author":[{"given":"Hayoung","family":"Ahn","sequence":"first","affiliation":[{"name":"Graduate School of AI, Pohang University of Science and Technology, Pohang 37673, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sungwoo","family":"Hur","sequence":"additional","affiliation":[{"name":"Graduate School of AI, Pohang University of Science and Technology, Pohang 37673, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cheol Hyun","family":"Lee","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Deagu 42601, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5876-1791","authenticated-orcid":false,"given":"Se Hun","family":"Kang","sequence":"additional","affiliation":[{"name":"Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam 13488, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daeung","family":"Ohn","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Eunpyeong St. Mary\u2019s Hospital, College of Medicine, The Catholic University of Korea, Seoul 03312, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"SookJung","family":"Kim","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Eunpyeong St. Mary\u2019s Hospital, College of Medicine, The Catholic University of Korea, Seoul 03312, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0617-3116","authenticated-orcid":false,"given":"Junghoon","family":"Lee","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Eunpyeong St. Mary\u2019s Hospital, College of Medicine, The Catholic University of Korea, Seoul 03312, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0720-1449","authenticated-orcid":false,"given":"Yeon-Jik","family":"Choi","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Eunpyeong St. Mary\u2019s Hospital, College of Medicine, The Catholic University of Korea, Seoul 03312, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeong-Eun","family":"Yi","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Eunpyeong St. Mary\u2019s Hospital, College of Medicine, The Catholic University of Korea, Seoul 03312, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2424-5275","authenticated-orcid":false,"given":"Suk Min","family":"Seo","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Eunpyeong St. Mary\u2019s Hospital, College of Medicine, The Catholic University of Korea, Seoul 03312, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5272-0665","authenticated-orcid":false,"given":"Sung-Won","family":"Jang","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Eunpyeong St. Mary\u2019s Hospital, College of Medicine, The Catholic University of Korea, Seoul 03312, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Won Hwa","family":"Kim","sequence":"additional","affiliation":[{"name":"Graduate School of AI, Pohang University of Science and Technology, Pohang 37673, Republic of Korea"},{"name":"Computer Science and Engineering, Pohang University of Science and Technology, Pohang 37673, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Osung","family":"Kwon","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Eunpyeong St. Mary\u2019s Hospital, College of Medicine, The Catholic University of Korea, Seoul 03312, Republic of Korea"},{"name":"Institut Cardiovasculaire Paris-Sud, H\u00f4pital Priv\u00e9 Jacques Cartier, Ramsay-Sant\u00e9, 91300 Massy, France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,7]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2582938","DOI":"10.1155\/2020\/2582938","article-title":"TAVR: A Review of Current Practices and Considerations in Low-Risk Patients","volume":"2020","author":"Spears","year":"2020","journal-title":"J. Interv. Cardiol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1049","DOI":"10.1161\/CIRCULATIONAHA.117.028352","article-title":"Conduction Disturbances After Transcatheter Aortic Valve Replacement: Current Status and Future Perspectives","volume":"136","author":"Auffret","year":"2017","journal-title":"Circulation"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2391","DOI":"10.1016\/j.jacc.2020.08.050","article-title":"2020 ACC Expert Consensus Decision Pathway on Management of Conduction Disturbances in Patients Undergoing Transcatheter Aortic Valve Replacement: A Report of the American College of Cardiology Solution Set Oversight Committee","volume":"76","author":"Lilly","year":"2020","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"544","DOI":"10.1002\/clc.22567","article-title":"The Prognostic Impact of New-Onset Persistent Left Bundle Branch Block Following Transcatheter Aortic Valve Implantation: A Meta-analysis","volume":"39","author":"Ando","year":"2016","journal-title":"Clin. Cardiol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1599","DOI":"10.1093\/eurheartj\/eht376","article-title":"Clinical implications of new-onset left bundle branch block after transcatheter aortic valve replacement: Analysis of the PARTNER experience","volume":"35","author":"Nazif","year":"2014","journal-title":"Eur. Heart J."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1016\/j.amjcard.2010.09.015","article-title":"Frequency of conduction abnormalities after transcatheter aortic valve implantation with the Medtronic-CoreValve and the effect on left ventricular ejection fraction","volume":"107","author":"Tzikas","year":"2011","journal-title":"Am. J. Cardiol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1175","DOI":"10.1016\/j.jcin.2019.03.025","article-title":"Long-Term Outcomes in Patients With New-Onset Persistent Left Bundle Branch Block Following TAVR","volume":"12","author":"Chamandi","year":"2019","journal-title":"JACC Cardiovasc. Interv."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"7499","DOI":"10.1109\/TNNLS.2022.3229161","article-title":"Deep Neural Networks and Tabular Data: A Survey","volume":"35","author":"Borisov","year":"2024","journal-title":"IEEE Trans. Neural Netw. Learn. Syst."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1109\/4235.585893","article-title":"No free lunch theorems for optimization","volume":"1","author":"Wolpert","year":"1997","journal-title":"IEEE Trans. Evol. Comput."},{"key":"ref_10","unstructured":"Paszke, A., Gross, S., Massa, F., Lerer, A., Bradbury, J., Chanan, G., Killeen, T., Lin, Z., Gimelshein, N., and Antiga, L. (2019). Pytorch: An imperative style, high-performance deep learning library. arXiv."},{"key":"ref_11","unstructured":"Ahn, H., Hur, S., Lee, C.H., Kang, S.H., Ohn, D., Kim, S., Lee, J., Choi, Y., Yi, J., and Seo, S.M. (2025, November 01). LBBB Feature Tokenizer\u2013Transformer Implementation (Version 1.0). Available online: https:\/\/github.com\/ahnha-ahnha\/lbbb-ft-main."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1016\/j.jcin.2020.09.063","article-title":"Incidence, Predictors, and Implications of Permanent Pacemaker Requirement After Transcatheter Aortic Valve Replacement","volume":"14","author":"Sammour","year":"2021","journal-title":"JACC Cardiovasc. Interv."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Yu, Q., Fu, Q., Xia, Y., and Wu, Y. (2024). Predictors, clinical impact, and management strategies for conduction abnormalities after transcatheter aortic valve replacement: An updated review. Front. Cardiovasc. Med., 11.","DOI":"10.3389\/fcvm.2024.1370244"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1016\/j.jcin.2013.08.015","article-title":"Impact of new-onset persistent left bundle branch block on late clinical outcomes in patients undergoing transcatheter aortic valve implantation with a balloon-expandable valve","volume":"7","author":"Urena","year":"2014","journal-title":"JACC Cardiovasc. Interv."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1186\/s12968-017-0335-9","article-title":"The impact of trans-catheter aortic valve replacement induced left-bundle branch block on cardiac reverse remodeling","volume":"19","author":"Dobson","year":"2017","journal-title":"J. Cardiovasc. Magn. Reson."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1016\/j.jcin.2014.07.022","article-title":"Predictors and clinical outcomes of permanent pacemaker implantation after transcatheter aortic valve replacement: The PARTNER (Placement of AoRtic TraNscathetER Valves) trial and registry","volume":"8","author":"Nazif","year":"2015","journal-title":"JACC Cardiovasc. Interv."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e003635","DOI":"10.1161\/CIRCINTERVENTIONS.115.003635","article-title":"Impact of New-Onset Left Bundle Branch Block and Periprocedural Permanent Pacemaker Implantation on Clinical Outcomes in Patients Undergoing Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-Analysis","volume":"9","author":"Regueiro","year":"2016","journal-title":"Circ. Cardiovasc. Interv."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Wang, J., Liu, S., Han, X., Chen, Y., Chen, H., Wan, Z., and Song, B. (2022). Prognostic Outcome of New-Onset Left Bundle Branch Block After Transcatheter Aortic Valve Replacement in Patients With Aortic Stenosis: A Systematic Review and Meta-Analysis. Front. Cardiovasc. Med., 9.","DOI":"10.3389\/fcvm.2022.842929"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1007\/s10840-017-0303-1","article-title":"Predictors of right ventricular pacing and pacemaker dependence in transcatheter aortic valve replacement patients","volume":"51","author":"Sharma","year":"2018","journal-title":"J. Interv. Card. Electrophysiol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1334","DOI":"10.1002\/clc.23447","article-title":"Predictors of ventricular pacing burden after permanent pacemaker implantation following transcatheter aortic valve replacement","volume":"43","author":"Elzeneini","year":"2020","journal-title":"Clin. Cardiol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"90","DOI":"10.31083\/j.rcm2303090","article-title":"Current Opinions on New-Onset Left Bundle Branch Block after Transcatheter Aortic Valve Replacement and the Search for Physiological Pacing","volume":"23","author":"Zhang","year":"2022","journal-title":"Rev. Cardiovasc. Med."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1007\/s10840-020-00813-y","article-title":"Predictors of conduction recovery after permanent pacemaker implantation following transcatheter aortic valve replacement","volume":"61","author":"Phan","year":"2021","journal-title":"J. Interv. Card. Electrophysiol."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Mangieri, A., Montalto, C., Pagnesi, M., Lanzillo, G., Demir, O., Testa, L., Colombo, A., and Latib, A. (2018). TAVI and Post Procedural Cardiac Conduction Abnormalities. Front. Cardiovasc. Med., 5.","DOI":"10.3389\/fcvm.2018.00085"}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/10\/1422\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T12:42:00Z","timestamp":1778157720000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/10\/1422"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,7]]},"references-count":23,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2026,5]]}},"alternative-id":["diagnostics16101422"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics16101422","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,7]]}}}