Transcatheter Heart Valve Selection and Permanent Pacemaker Implantation in Patients With Pre‐Existent Right Bundle Branch Block
Why the study?
Does the choice of transcatheter heart valve affect the rate of permanent pacemaker implantation in TAVR patients with pre-existent right bundle branch block?
Population
306 patients undergoing transcatheter aortic valve replacement with pre-existent right bundle branch block…
Comparison
Transcatheter aortic valve replacement using… vs Comparison among the different transcatheter…
Design
Cohort
Follow-up
1 year
Authors
Discussion
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Member takes
Implication
May warrant caution in valve selection for RBBB patients post-TAVR; leaves open optimal device choice pending randomized confirmation.
Key Points
- The study evaluates pacemaker implantation rates post-transcatheter aortic valve replacement in patients with pre-existing right bundle branch block.
- Pooled data from 306 patients at 4 high-volume European centers
- Used logistic regression to analyze pacemaker implantation rates among different valve designs
- Included patients without a previous pacemaker at baseline with mean age of 83 years
- Overall pacemaker implantation rate was 41% following transcatheter aortic valve replacement
- Rate was 75% for Lotus, 46% for CoreValve, 32% for ES-XT, and 34% for ES-3
- 81% had ventricular paced rhythm at 30-day follow-up, which increased to 89% at 1 year
Structured PICO
Does the choice of transcatheter heart valve affect the rate of permanent pacemaker implantation in TAVR patients with pre-existent right bundle branch block?
P
Population
306 patients undergoing transcatheter aortic valve replacement (TAVR) with pre-existent right bundle branch block (RBBB) at baseline without a previously implanted permanent pacemaker, from 4 high-volume centers in Europe. Mean age 83±7 years, 63% male, median STS score 6.3.
I
Intervention
Transcatheter aortic valve replacement using specific valve designs (Medtronic CoreValve [n=130], Edwards Sapien XT [n=124], Edwards Sapien 3 [n=32], or Boston Scientific Lotus [n=20])
C
Comparator
Comparison among the different transcatheter heart valve designs
O
Outcome
Permanent pacemaker (PPM) implantation rate post-transcatheter aortic valve replacementsafety
In TAVR patients with pre-existing right bundle branch block, the rate of permanent pacemaker implantation is high (41%) and varies significantly by valve type, being highest with the Lotus valve.
Cite This Study
Gils et al. (2017) studied this question.