Baseline right bundle branch block strongly predicted new pacemaker implantation at 90 days after transcatheter aortic valve implantation (28.3% vs. 7.1%; HR 4.61, 95% CI 3.60-5.91).
Cohort (n=4,900)
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Does pre-existing right bundle branch block increase the risk of pacemaker implantation, heart failure, or mortality in patients undergoing transcatheter aortic valve implantation?
In patients undergoing TAVI, pre-existing right bundle branch block strongly predicts the need for permanent pacemaker implantation but does not increase the risk of heart failure or all-cause mortality at up to 1 year.
Hazard Ratio: 4.61 (95% CI 3.6–5.91)
Tasa de eventos absoluta: 28.3% vs 7.1%
Abstract Aims In the largest nationwide study of Danish patients undergoing transcatheter aortic valve implantation, we examined the clinical impact of pre-existing right bundle branch block—a known risk factor for permanent pacemaker implantation—on outcomes including pacemaker implantation, heart failure, and all-cause mortality. Methods and Results We included first-time transcatheter aortic valve implantation patients in Denmark from 2008–2021. Patients were stratified by baseline right bundle branch block status using the digital Danish Nationwide Electrocardiogram Cohort. The study outcomes were new pacemaker implantation, heart failure, and all-cause mortality at 30, 90, and 365 days. A composite of the study outcomes was also assessed. A total of 4,900 patients were included, of whom 438 (9%) had baseline right bundle branch block. Mean age was 81 years, 55% were male. At 90 days, the overall pacemaker implantation incidence was 9%, but markedly higher in the right bundle branch block group: 28.3% vs. 7.1% (HR 4.61, 95% CI 3.60–5.91). Right bundle branch block was not associated with higher rates of heart failure (10.1% vs. 8.3%; HR 1.23, 95% CI 0.86–1.77) or death (3.7% vs. 3.6%; HR 1.08, 95% CI 0.64–1.82). The findings were consistent at one year. Conclusion In this comprehensive nationwide cohort, right bundle branch block strongly predicted pacemaker implantation after transcatheter aortic valve implantation but importantly, not heart failure or all-cause mortality. The neutral association with heart failure and mortality should be explored further.
Steiner et al. (Mié,) realizaron una cohorte en la implantación de válvula aórtica transcateter (n=4,900). Se evaluó el bloqueo de rama derecha en la línea base frente a la ausencia de bloqueo de rama derecha en la línea base sobre la implantación de nuevo marcapasos a los 90 días (HR 4.61, IC 95% 3.60-5.91). El bloqueo de rama derecha en la línea base predijo fuertemente la implantación de nuevo marcapasos a los 90 días después de la implantación de la válvula aórtica transcateter (28.3% frente a 7.1%; HR 4.61, IC 95% 3.60-5.91).