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Updated: Oct 30, 2025
Upper-extremity Approach for Secondary Access in Transfemoral Transcatheter Aortic Valve Implantation
Published on: August 8, 2025
Impact of Bundle Branch Block on Permanent Pacemaker Implantation after Transcatheter Aortic Valve Implantation: A
Justine M Ravaux1, Michele Di Mauro1, Kevin Vernooy2,3,4
1Department of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC), 6202 AZ Maastricht, The Netherlands.
Insights
Right bundle branch block (RBBB) significantly increases the risk of permanent pacemaker implantation after transcatheter aortic valve implantation (TAVI). Left bundle branch block (LBBB) showed no significant impact on post-TAVI pacemaker needs.
Area of Science:
- Cardiology
- Interventional Cardiology
- Electrophysiology
Background:
- Transcatheter aortic valve implantation (TAVI) is a common procedure for aortic stenosis.
- Conduction disturbances, particularly bundle branch blocks (BBB), can complicate TAVI.
- Limited data exists on the impact of pre-existing infra-Hisian conduction disturbances on permanent pacemaker implantation (PPI) post-TAVI.
Purpose of the Study:
- To determine the impact of right bundle branch block (RBBB) and/or left bundle branch block (LBBB) on the need for permanent pacemaker implantation (PPI) after TAVI.
Main Methods:
- Systematic literature review and meta-analysis.
- Inclusion of 36 studies with 55,851 patients.
- Analysis of pre-implant RBBB/LBBB status and post-TAVI PPI rates, calculating odds ratios (ORs).
Main Results:
- Pre-implant LBBB (11.9%) did not significantly influence post-TAVI PPI (OR 1.1474, p=0.2618).
- Pre-implant RBBB (9.2%) significantly increased the risk of post-TAVI PPI (OR 4.8581, p<0.0001).
- The association of RBBB with PPI was independent of age or left ventricular ejection fraction (LVEF).
Conclusions:
- Right bundle branch block is a significant predictor of permanent pacemaker implantation after TAVI.
- Left bundle branch block does not appear to be a significant predictor.
- Pre-operative evaluation of conduction status, particularly RBBB, is crucial for patient selection and risk stratification in TAVI procedures.
Abstract:
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.
