Prophylactic permanent pacemaker strategy in patients with right bundle branch block undergoing transcatheter aortic...

Area of Science:

• Cardiology
• Interventional Cardiology
• Cardiac Electrophysiology

Background:

• Pre-existing right bundle branch block (RBBB) is a known predictor of permanent pacemaker (PPM) implantation after transcatheter aortic valve replacement (TAVR).
• RBBB post-TAVR is associated with increased patient mortality.

Purpose of the Study:

• To evaluate the impact of a selective prophylactic permanent pacemaker (PPx-PPM) implantation strategy.
• To compare outcomes in TAVR patients with RBBB treated with and without PPx-PPM.

Main Methods:

• Retrospective comparison of TAVR patients with RBBB from 2013-2020.
• Analysis of hospital patient flow and clinical endpoints between periods with and without selective PPx-PPM.

Main Results:

• A PPx-PPM was implanted in 44% of patients in the selective strategy group.
• The selective PPx-PPM strategy was associated with significantly shorter TAVR procedural times and hospital length of stay.
• Cardiac rehospitalization was significantly higher in the group without PPx-PPM, primarily due to early pacemaker implantations.

Conclusions:

• Selective prophylactic PPM implantation in TAVR candidates with RBBB improves procedural efficiency and reduces hospital length of stay.
• This strategy effectively prevents early cardiac rehospitalization linked to complete heart block after TAVR.