Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease (May 2024)

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

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

DOI
https://doi.org/10.1161/JAHA.123.032777
Journal volume & issue
Vol. 13, no. 9

Abstract

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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.

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