Clinical validation of the 2021 European Society of Cardiology guidelines on preexisting right bundle branch block in patients undergoing transcatheter aortic valve implantation

BACKGROUND: Risk stratification of patients with right bundle branch block (RBBB) undergoing transcatheter aortic valve implantation (TAVI) remains challenging. OBJECTIVE: This study aimed to evaluate the European Society of Cardiology (ESC) criteria for risk stratification of RBBB patients undergoing TAVI. METHODS: We retrospectively analyzed prospectively enrolled patients with preexisting RBBB undergoing TAVI between 2011 and 2023. A surface 12-lead electrocardiogram was available before and after the procedure in all patients. The following ESC criteria were validated: ΔPR interval ≥20 ms, QRS axis change, and transient high-degree atrioventricular block (HAVB) <24 hours after TAVI. RESULTS: Preexisting RBBB was documented in 107 of 1410 patients (7.6%) undergoing TAVI. Mean age was 83 ± 5 years, 34% were female, and 66% received self-expandable valves. Of those 107 patients with preexisting RBBB, 36 (34%) had persistent HAVB lasting longer than 24 hours and received permanent pacemaker therapy. Of the remaining 71 patients, 16 patients (23%) had delayed HAVB during 30 days of follow-up. The ESC criteria identified 81% of patients (13/16) with delayed HAVB during 30-day follow-up while missing 3 patients (19%; 2.8% of the overall cohort). This resulted in a sensitivity of 81% and a negative predictive value of 92%. Meeting the ESC criteria bore a 6-fold increase in the odds for development of HAVB during 30-day follow-up (odds ratio, 6.5; 95% confidence interval, 1.84-30.8; P = .007). CONCLUSION: In this large cohort of patients with preexisting RBBB undergoing TAVI with contemporary prosthesis and implantation techniques, the ESC criteria-PR prolongation, QRS axis change, and transient HAVB-correctly identified 4 of 5 patients in whom HAVB developed during 30-day follow-up.