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

• Published in: Journal of the American Heart Association 2024-05, Vol.13 (9), p.e032777-e032777
• Main Authors: Kikuchi, Shinnosuke, Minamimoto, Yugo, Matsushita, Kensuke, Cho, Tomoki, Terasaka, Kengo, Hanajima, Yohei, Nakahashi, Hidefumi, Gohbara, Masaomi, Kimura, Yuichiro, Yasuda, Shota, Okada, Kozo, Matsuzawa, Yasushi, Iwahashi, Noriaki, Kosuge, Masami, Ebina, Toshiaki, Morel, Olivier, Ohlmann, Patrick, Uchida, Keiji, Hibi, Kiyoshi
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Aortic Valve Stenosis - surgery; Atrioventricular Block - diagnosis; Atrioventricular Block - etiology; Atrioventricular Block - physiopathology; Atrioventricular Block - therapy; Bundle-Branch Block - diagnosis; Bundle-Branch Block - etiology; Bundle-Branch Block - physiopathology; Bundle-Branch Block - therapy; Cardiac Pacing, Artificial - adverse effects; Cardiology and cardiovascular system; complete atrioventricular block; Electrocardiography; Female; Human health and pathology; Humans; Life Sciences; Male; new‐onset right bundle‐branch block; Original Research; Pacemaker, Artificial; permanent pacemaker implantation; Postoperative Complications - diagnosis; Postoperative Complications - etiology; Postoperative Complications - therapy; Recurrence; Retrospective Studies; Risk Factors; Time Factors; transcatheter aortic valve replacement; Transcatheter Aortic Valve Replacement - adverse effects; Treatment Outcome
• ISSN: 2047-9980; 2047-9980
• DOI: 10.1161/JAHA.123.032777

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. 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%,