Impact of New‐Onset Right Bundle‐Branch Block After Transcatheter Aortic Valve Replacement on Permanent Pacemaker Implantation

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[Released on 16/05/2024]

Authors: Shinnosuke Kikuchi MD , Yugo Minamimoto MD , Kensuke Matsushita MD , Tomoki Cho MD , Kengo Terasaka MD , Yohei Hanajima MD , Hidefumi Nakahashi MD , Masaomi Gohbara MD , Yuichiro Kimura MD , Shota Yasuda MD , Kozo Okada MD , Yasushi Matsuzawa MD , Noriaki Iwahashi MD , Masami Kosuge MD , Toshiaki Ebina MD , Olivier Morel MD , Patrick Ohlmann MD , Keiji Uchida MD , Kiyoshi Hibi MD

Abstract

Background A delayed and recurrent complete atrioventricular block (CAVB) is a life‐threatening complication of transcatheter aortic valve replacement (TAVR). Post‐TAVR evaluation may be important in predicting delayed and recurrent CAVB requiring permanent pacemaker implantation (PPI). The impact of new‐onset right bundle‐branch block (RBBB) after TAVR on PPI remains unknown.
Methods and Results In total, 407 patients with aortic stenosis who underwent TAVR were included in this analysis. Intraprocedural CAVB was defined as CAVB that occurred during TAVR. A 12‐lead ECG was evaluated at baseline, immediately after TAVR, on postoperative days 1 and 5, and according to the need to identify new‐onset bundle‐branch block (BBB) and CAVB after TAVR. Forty patients (9.8%) required PPI, 17 patients (4.2%) had persistent intraprocedural CAVB, and 23 (5.7%) had delayed or recurrent CAVB after TAVR. The rates of no new‐onset BBB, new‐onset left BBB, and new‐onset RBBB were 65.1%, 26.8%, and 4.7%, respectively. Compared with patients without new‐onset BBB and those with new‐onset left BBB, the rate of PPI was higher in patients with new‐onset RBBB (3.4% versus 5.6% versus 44.4%, P<0.0001). On post‐TAVR evaluation in patients without persistent intraprocedural CAVB, the multivariate logistic regression analysis showed that new‐onset RBBB was a statistically significant predictor of PPI compared with no new‐onset BBB (odds ratio [OR], 18.0 [95% CI, 5.94–54.4]) in addition to the use of a self‐expanding valve (OR, 2.97 [95% CI, 1.09–8.10]).
Conclusions Patients with new‐onset RBBB after TAVR are at high risk for PPI.

Keywords: complete atrioventricular block; new‐onset right bundle‐branch block; permanent pacemaker implantation; transcatheter aortic valve replacement.

Nonstandard Abbreviations and Acronyms

  • BBB
  • bundle‐branch block
  • CAVB
  • complete atrioventricular block
  • PPI
  • permanent pacemaker implantation
  • TAVR
  • transcatheter aortic valve replacement
  • THV
  • transcatheter heart valve

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Impact of New‐Onset Right Bundle‐Branch Block After Transcatheter Aortic Valve Replacement on Permanent Pacemaker Implantation

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Abstract

Background A delayed and recurrent complete atrioventricular block (CAVB) is a life‐threatening complication of transcatheter aortic valve replacement (TAVR). Post‐TAVR evaluation may be important in predicting delayed and recurrent CAVB requiring permanent pacemaker implantation (PPI). The impact of new‐onset right bundle‐branch block (RBBB) after TAVR on PPI remains unknown.
Methods and Results In total, 407 patients with aortic stenosis who underwent TAVR were included in this analysis. Intraprocedural CAVB was defined as CAVB that occurred during TAVR. A 12‐lead ECG was evaluated at baseline, immediately after TAVR, on postoperative days 1 and 5, and according to the need to identify new‐onset bundle‐branch block (BBB) and CAVB after TAVR. Forty patients (9.8%) required PPI, 17 patients (4.2%) had persistent intraprocedural CAVB, and 23 (5.7%) had delayed or recurrent CAVB after TAVR. The rates of no new‐onset BBB, new‐onset left BBB, and new‐onset RBBB were 65.1%, 26.8%, and 4.7%, respectively. Compared with patients without new‐onset BBB and those with new‐onset left BBB, the rate of PPI was higher in patients with new‐onset RBBB (3.4% versus 5.6% versus 44.4%, P<0.0001). On post‐TAVR evaluation in patients without persistent intraprocedural CAVB, the multivariate logistic regression analysis showed that new‐onset RBBB was a statistically significant predictor of PPI compared with no new‐onset BBB (odds ratio [OR], 18.0 [95% CI, 5.94–54.4]) in addition to the use of a self‐expanding valve (OR, 2.97 [95% CI, 1.09–8.10]).
Conclusions Patients with new‐onset RBBB after TAVR are at high risk for PPI.

Keywords: complete atrioventricular block; new‐onset right bundle‐branch block; permanent pacemaker implantation; transcatheter aortic valve replacement.

Nonstandard Abbreviations and Acronyms

  • BBB
  • bundle‐branch block
  • CAVB
  • complete atrioventricular block
  • PPI
  • permanent pacemaker implantation
  • TAVR
  • transcatheter aortic valve replacement
  • THV
  • transcatheter heart valve

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