Bibliographic Details
| Title: |
Risk Stratification and Management of Advanced Conduction Disturbances Following TAVI in Patients With Pre-Existing RBBB |
| Authors: |
Toshiaki Isogai, MD, MPH, Iryna Dykun, MD, Ankit Agrawal, MD, Shashank Shekhar, MD, Anas M. Saad, MD, Beni Rai Verma, MD, Omar M. Abdelfattah, MD, Ankur Kalra, MD, Amar Krishnaswamy, MD, Grant W. Reed, MD, MSc, Samir R. Kapadia, MD, Rishi Puri, MBBS, PhD |
| Source: |
Structural Heart, Vol 6, Iss 1, Pp 100006- (2022) |
| Publisher Information: |
Elsevier, 2022. |
| Publication Year: |
2022 |
| Collection: |
LCC:Diseases of the circulatory (Cardiovascular) system |
| Subject Terms: |
Complete heart block, Implantation depth, Permanent pacemaker, Right bundle branch block, Transcatheter aortic valve implantation, Diseases of the circulatory (Cardiovascular) system, RC666-701 |
| More Details: |
Background: Pre-existing right bundle branch block (RBBB) is a strong predictor of increased need for a permanent pacemaker (PPM) following transcatheter aortic valve implantation (TAVI). Yet, further risk stratification and management remain challenging in patients with pre-existing RBBB owing to limited data. Therefore, we sought to investigate the incidence, predictors, and management of advanced conduction disturbances after TAVI in patients with pre-existing RBBB. Methods: We retrospectively reviewed 261 consecutive patients with pre-existing RBBB (median age 81 years; 28.0% female; 95.0% received a balloon-expandable valve) without a pre-existing PPM who underwent TAVI at our institution in 2015-2019. Outcomes were high-degree atrioventricular block/complete heart block (HAVB/CHB) and PPM requirement. Results: Overall, the 30-day HAVB/CHB rate was 28.0%, of which 76.7% occurred during the TAVI procedure. The delayed HAVB/CHB rate was 8.3%. Implantation depth below aortic annulus (per 1-mm increase) was significantly associated with increased risk of procedural HAVB/CHB (adjusted odds ratio = 1.25, 95% confidence interval = 1.07-1.46), delayed HAVB/CHB (1.34 [1.01-1.79]), and 30-day PPM (1.32 [1.11-1.55]). Predilation was associated with delayed HAVB/CHB (4.02 [1.22-13.23]). The combination of no predilation and implantation depth of ≤2.0 mm had lower rates of procedural HAVB/CHB (11.2% vs. 26.7%-30.4%, p = 0.011), delayed HAVB/CHB (2.1% vs. 7.6%-28.1%, p < 0.001), and 30-day PPM (10.3% vs. 20.0%-43.5%, p < 0.001) than the other strategies of valve deployment. Complete HAVB/CHB recovery after PPM implantation was uncommon at 7.1%. Conclusions: In patients with pre-existing RBBB, the majority of HAVB/CHB events occurred during the TAVI procedure. Avoidance of predilation coupled with high valve deployment may result in relatively low rates of procedural and delayed HAVB/CHB, along with 30-day PPM rates. |
| Document Type: |
article |
| File Description: |
electronic resource |
| Language: |
English |
| ISSN: |
2474-8706 |
| Relation: |
http://www.sciencedirect.com/science/article/pii/S2474870622010569; https://doaj.org/toc/2474-8706 |
| DOI: |
10.1016/j.shj.2022.100006 |
| Access URL: |
https://doaj.org/article/c9a0387a4a7c48e289c345f0838e0af8 |
| Accession Number: |
edsdoj.9a0387a4a7c48e289c345f0838e0af8 |
| Database: |
Directory of Open Access Journals |
