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Timing and evolution of advanced conduction disturbances in patients with right bundle branch block undergoing

Guillem Muntané-Carol1, David Del Val1, Lucía Junquera1

  • 1Quebec Heart and Lung Institute, Laval University, Quebec City, QC, Canada.

Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology
|September 2, 2020
PubMed

Insights

Advanced conduction disturbances (CDs) are common after transcatheter aortic valve replacement (TAVR) in patients with right bundle branch block (RBBB), often occurring within 3 days and rarely recovering. This highlights the need for careful monitoring and planning for permanent pacemaker implantation (PPMI).

Area of Science:

  • Cardiology
  • Cardiac Electrophysiology
  • Interventional Cardiology

Background:

  • Transcatheter aortic valve replacement (TAVR) is a growing procedure for aortic stenosis.
  • Right bundle branch block (RBBB) is a common baseline electrocardiographic finding.
  • The impact of pre-existing RBBB on conduction disturbances (CDs) post-TAVR requires further elucidation.

Purpose of the Study:

  • To investigate the timing and long-term evolution of advanced CDs in patients with baseline RBBB undergoing TAVR.
  • To assess the rate and predictors of permanent pacemaker implantation (PPMI) in this patient cohort.

Main Methods:

  • A cohort of 110 patients with pre-existing RBBB undergoing TAVR was analyzed.
  • Arrhythmias were recorded during hospitalization, with follow-up at 30 days, 1 year, and annually thereafter.
  • Conduction recovery and ventricular pacing percentage (VPP) were evaluated at 30 days for patients with PPMI.

Main Results:

  • Over half (55.5%) of patients with RBBB developed advanced CDs, predominantly complete or high-degree atrioventricular block (CHB/HAVB) (97%).
  • The majority of CDs (98%) occurred within 3 days post-TAVR, with 85% being intraprocedural.
  • Nearly half (47.3%) required PPMI, a significantly higher rate than in non-RBBB patients (11.0%).
  • Complete conduction recovery was rare (2%). Patients with persistent intraprocedural CHB/HAVB had higher VPP at 1 month.
  • A higher risk of PPMI was observed at 4-year follow-up in RBBB patients compared to non-RBBB patients (26% vs. 8%).

Conclusions:

  • Advanced CDs post-TAVR in RBBB patients typically manifest early and show limited recovery.
  • The high rate of PPMI in this group necessitates careful consideration for device implantation timing and hospitalization duration.
  • Pre-existing RBBB is a significant predictor of long-term PPMI after TAVR.
Abstract

Keywords:
Conduction disturbancesRight bundle branch blockTranscatheter aortic valve implantation

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