Key result
New-onset RBBB after TAVR is linked to an ~8-fold higher risk of 90-day PPM implantation.
Why the study?
The incidence and prognosis of right bundle branch block following transcatheter aortic valve replacement were unknown.
Does new-onset RBBB following TAVR increase the risk of permanent pacemaker implantation and mortality in patients with severe symptomatic aortic stenosis?
Cohort (n=1,992)
Yes
Does new-onset RBBB following TAVR increase the risk of permanent pacemaker implantation and mortality in patients with severe symptomatic aortic stenosis?
Hazard Ratio: 8.36 (95% CI 4.19–16.7)
Absolute Event Rate: 66.7% vs 13.6%
p-value: p=<0.001
Although rare (0.75%), new-onset right bundle branch block following TAVR is strongly associated with a high risk of requiring permanent pacemaker implantation within 90 days.
New-onset RBBB after TAVR may warrant closer PPM monitoring; leaves open optimal surveillance strategies pending prospective validation.
BACKGROUND: The incidence and prognosis of right bundle branch block (RBBB) following transcatheter aortic valve replacement (TAVR) are unknown. Hence, we sought to characterize the incidence of post-TAVR RBBB and determine associated risks of permanent pacemaker (PPM) implantation and mortality. METHODS: All patients 18 years and above without preexisting RBBB or PPM who underwent TAVR at US Mayo Clinic sites and Mayo Clinic Health Systems from June 2010 to May 2021 were evaluated. Post-TAVR RBBB was defined as new-onset RBBB in the postimplantation period. The risks of PPM implantation (within 90 days) and mortality following TAVR were compared for patients with and without post-TAVR RBBB using Kaplan-Meier analysis and Cox proportional hazards modeling. The risks of PPM implantation (within 90 days) and mortality following TAVR were compared for patients with and without post-TAVR RBBB using Kaplan-Meier analysis and Cox proportional hazards modeling. RESULTS: Of 1992 patients, 15 (0.75%) experienced new RBBB post-TAVR. There was a higher degree of valve oversizing among patients with new RBBB post-TAVR versus those without (17.9% versus 10.0%; P =0.034). Ten patients (66.7%) with post-TAVR RBBB experienced high-grade atrioventricular block and underwent PPM implantation (median 1 day; Q1, 0.2 and Q3, 4), compared with 268/1977 (13.6%) without RBBB. Following propensity score adjustment for covariates (age, sex, balloon-expandable valve, annulus diameter, and valve oversizing), post-TAVR RBBB was significantly associated with PPM implantation (hazard ratio, 8.36 [95% CI, 4.19–16.7]; P <0.001). No statistically significant increase in mortality was seen with post-TAVR RBBB (hazard ratio, 0.83 [95% CI, 0.33–2.11]; P =0.69), adjusting for age and sex. CONCLUSIONS: Although infrequent, post-TAVR RBBB was associated with elevated PPM implantation risk. The mechanisms for its development and its clinical prognosis require further study.
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Tan et al. (2024) conducted a cohort in Severe symptomatic aortic stenosis undergoing TAVR (n=1,992). New-onset right bundle branch block (RBBB) post-TAVR vs. No post-TAVR RBBB was evaluated on Permanent pacemaker (PPM) implantation within 90 days (HR 8.36, 95% CI 4.19-16.7, p=<0.001). New-onset right bundle branch block following transcatheter aortic valve replacement was associated with a significantly increased risk of permanent pacemaker implantation within 90 days (HR 8.36).
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