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Updated: Dec 7, 2025
Upper-extremity Approach for Secondary Access in Transfemoral Transcatheter Aortic Valve Implantation
Published on: August 8, 2025
Impact of baseline conduction abnormalities on outcomes after transcatheter aortic valve replacement with SAPIEN-3
Yasser Sammour1, Kimi Sato1, Arnav Kumar1
1Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
Insights
Right bundle branch block and first-degree atrioventricular block are key predictors for permanent pacemaker implantation after TAVR. Preexisting atrial fibrillation increases risks for mortality, stroke, and major adverse cardiac events post-TAVR.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Electrophysiology
Background:
- Conduction abnormalities are established risk factors for permanent pacemaker (PPM) implantation following transcatheter aortic valve replacement (TAVR).
- Understanding the specific impact of baseline conduction defects on TAVR outcomes is crucial for patient management.
Purpose of the Study:
- To investigate the influence of baseline conduction abnormalities, including right bundle branch block (RBBB), left bundle branch block (LBBB), left anterior hemiblock (LAHB), first-degree atrioventricular block (AVB), and atrial fibrillation/flutter (AF), on TAVR outcomes.
- To identify independent predictors of PPM implantation and assess the long-term effects of these conduction defects on left ventricular ejection fraction (LVEF), major adverse cardiac and cerebrovascular events (MACCE), and mortality.
Main Methods:
- A cohort of 886 consecutive patients undergoing transfemoral TAVR with SAPIEN-3 (S3) were analyzed.
- Patients with prior PPM, nontransfemoral access, or valve-in-valve procedures were excluded.
- Statistical analysis was performed to determine the association between baseline conduction abnormalities and 30-day PPM, as well as long-term outcomes including LVEF, stroke/TIA, MACCE, and mortality.
Main Results:
- Baseline RBBB (OR 4.005) and first-degree AVB (OR 1.847) were independent predictors of 30-day PPM implantation.
- Baseline LBBB and AF were associated with lower LVEF at baseline and 1 year post-TAVR, though changes in LVEF over time were similar.
- Preexisting AF was linked to increased rates of stroke/TIA (4.4%), 1-year MACCE (19.5%), and 2-year mortality (23.5%) compared to patients without AF.
Conclusions:
- In the S3 TAVR population, RBBB and first-degree AVB are significant predictors of higher PPM risk.
- Preexisting LBBB and AF are associated with reduced LVEF post-TAVR.
- Baseline AF independently predicts worse long-term outcomes, including increased mortality, stroke/TIA, and MACCE.
Background:
Baseline conduction abnormalities are known risk factors for permanent pacemaker (PPM) implantation after transcatheter aortic valve replacement (TAVR). We sought to determine the impact of baseline right bundle branch block (RBBB), left bundle branch block (LBBB), left anterior hemiblock (LAHB), first-degree atrioventricular block (AVB) and atrial fibrillation/flutter (AF) on TAVR outcomes.
Methods:
Consecutive patients who underwent transfemoral TAVR with SAPIEN-3 (S3) were included. We excluded patients with prior PPM, nontransfemoral access or valve-in-valve.
Results:
Among 886 patients, baseline RBBB was seen in 15.9%, LBBB in 6.3%, LAHB in 6.2%, first-degree AVB in 26.3% and AF in 37.5%. The rate of 30-day PPM was 10.1%. Baseline RBBB (OR 4.005; 95% CI 2.386-6.723; p < .001) and first-degree AVB (OR 1.847; 95% CI 1.133-3.009; p = .014) were independent predictors of 30 day PPM. LAHB also resulted in higher PPM rates but only in unadjusted analysis (21.8% vs. 9.4%; p = .003). Baseline LBBB and AF were associated with lower left ventricular ejection fraction (LVEF) at both baseline and 1 year after TAVR. However, Δ LVEF over time were noted to be similar with baseline LBBB (1.8% vs. 1.4%; p = .809) and AF (1.1% vs. 1.7%; p = .458). Moreover, baseline AF was also associated with higher stroke/transient ischemic attack (TIA) at 1 year (4.4% vs. 1.8%; p = .019), 1-year major adverse cardiac and cerebrovascular events (MACCE) (19.5% vs. 13.3%; p = .012) and 2 year mortality (23.5% vs. 15.2%; p = .016). None of the other baseline conduction defects affected long-term mortality or MACCE.
Conclusion:
In our S3 TAVR population, baseline RBBB and first-degree AVB predicted higher PPM risk. Prior LBBB and AF were associated with lower LVEF at both baseline and 1 year. Lastly, preexisting AF was associated with higher rates of mortality, stroke/TIA, and MACCE.
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