Pre-implant right bundle branch block significantly increased the risk of permanent pacemaker implantation after TAVI (OR 4.8581; 95% CI 4.1571-5.6775; p<0.0001), while left bundle branch block did not.
Meta-Analysis (n=55,851)
Does pre-implant right or left bundle branch block increase the risk of permanent pacemaker implantation after TAVI?
Pre-implant right bundle branch block, but not left bundle branch block, is a strong independent predictor for requiring a permanent pacemaker after transcatheter aortic valve implantation.
Odds Ratio: 4.8581 (95% CI 4.1571–5.6775)
p-value: p=<0.0001
Data regarding the impact of infra-Hisian conduction disturbances leading to permanent pacemaker implantation (PPI) after transcatheter aortic valve implantation (TAVI) remain limited. The aim of this study was to determine the impact of right and/or left bundle branch block (RBBB/LBBB) on post-TAVI PPI. We performed a systematic literature review to identify studies reporting on RBBB and/or LBBB status and post-TAVI PPI. Study design, patient characteristics, and the presence of branch block were analyzed. Odds ratios (ORs) with 95% CI were extracted. The final analysis included 36 studies, reporting about 55,851 patients. Data on LBBB were extracted from 33 studies. Among 51,026 patients included, 5503 showed pre-implant LBBB (11.9% (10.4%–13.8%)). The influence of LBBB on post-TAVI PPI was not significant OR 1.1474 (0.9025; 1.4588), p = 0.2618. Data on RBBB were extracted from 28 studies. Among 46,663 patients included, 31,603 showed pre-implant RBBB (9.2% (7.3%–11.6%)). The influence of RBBB on post-TAVI PPI was significant OR 4.8581 (4.1571; 5.6775), p < 0.0001. From this meta-analysis, the presence of RBBB increased the risk for post-TAVI PPI, independent of age or LVEF, while this finding was not confirmed for patients experimenting with LBBB. This result emphasizes the need for pre-operative evaluation strategies in patient selection for TAVI.
Ravaux et al. (Sat,) conducted a meta-analysis in Transcatheter aortic valve implantation (TAVI) (n=55,851). Right and/or left bundle branch block (RBBB/LBBB) vs. Absence of bundle branch block was evaluated on Permanent pacemaker implantation (PPI) after TAVI (OR 4.8581, 95% CI 4.1571-5.6775, p=<0.0001). Pre-implant right bundle branch block significantly increased the risk of permanent pacemaker implantation after TAVI (OR 4.8581; 95% CI 4.1571-5.6775; p<0.0001), while left bundle branch block did not.