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Related Concept Videos

Aortic Regurgitation III: Medical Management01:25

Aortic Regurgitation III: Medical Management

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Aortic regurgitation (AR) is when the aortic valve does not close or seal properly, leading to backward blood circulation from the aorta into the left ventricle during diastole. Common causes of AR include rheumatic heart disease, congenital valve defects, and aortic root dilation. Managing AR requires a multifaceted approach to alleviate symptoms, preserve left ventricular function, and address the underlying cause of the regurgitation. Patients with symptomatic AR or significant left...
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Cardiac Catheterization II: Right Heart Catheterization01:21

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Right Heart Catheterization: An OverviewRight heart catheterization is an invasive diagnostic procedure that measures right-sided cardiac and pulmonary artery pressures, calculates cardiac output, and identifies intracardiac shunts. It provides detailed hemodynamic data essential for diagnosing and managing various cardiovascular conditions, such as pulmonary hypertension.Access SitesCommon access sites for right heart catheterization include the internal jugular vein in the neck region, the...
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Aortic Regurgitation I: Introduction01:15

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IntroductionAortic regurgitation is characterized by the backward flow of blood from the aorta into the left ventricle during diastole and arises from the improper closure of the aortic valve. This condition results in left ventricular volume overload and can stem from both acute and chronic etiologies, each contributing uniquely to the disease's progression and symptomatology.Acute and Chronic CausesAcute aortic regurgitation often results from events that suddenly impair the integrity of the...
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Dysrhythmias IV: Characteristics of Bradyarrhythmias01:18

Dysrhythmias IV: Characteristics of Bradyarrhythmias

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Bradyarrhythmias are cardiac rhythm disorders characterized by a slower-than-normal heart rate, typically defined as fewer than 60 beats per minute. Some of which are discussed here:Sinus BradycardiaSinus bradycardia presents a heart rate lower than 60 beats per minute, with a regular rhythm originating from the SA node. The ECG typically shows normal P waves preceding each QRS complex, a normal PR interval (0.12 to 0.20 seconds), and a normal QRS duration (0.06 to 0.10 seconds).First-Degree AV...
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Aortic Regurgitation II: Clinical Features and Diagnostic Tests01:22

Aortic Regurgitation II: Clinical Features and Diagnostic Tests

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Aortic valve regurgitation (AR) occurs when the aortic valve fails to close properly, allowing blood to flow backward from the aorta into the left ventricle. This backflow can result in two distinct clinical presentations: acute and chronic AR, each characterized by its own set of symptoms and physical findings.Acute Aortic RegurgitationAcute AR presents with a sudden onset of severe symptoms. Patients typically experience profound dyspnea (shortness of breath), chest pain, and signs of left...
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Mitral Valve Prolapse II: Assessment and Management01:22

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IntroductionA range of clinical features characterizes Mitral Valve Prolapse (MVP), but it is important to note that many individuals with MVP are asymptomatic and may remain so throughout their lives. For those who do exhibit symptoms, the following are the key clinical features:Palpitations: This is a common symptom where individuals feel an irregular or rapid heartbeat. Palpitations in MVP are often due to arrhythmias such as premature ventricular contractions or supraventricular...
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Pacemaker Risk Stratification in Patients With Pre-existing Right Bundle Branch Block Undergoing Transcatheter Aortic

Alejandro Travieso1, Jorge Nuche2, Gabriela Tirado-Conte3

  • 1Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Madrid, Spain. Electronic address: https://twitter.com/AlejandroTrav.

The Canadian Journal of Cardiology
|July 7, 2025
PubMed
Summary

Patients with right bundle branch block (RBBB) undergoing transcatheter aortic valve replacement (TAVR) have a high risk of permanent pacemaker implantation (PPI). Female sex, prolonged PR segment, and self-expanding valves predict higher PPI rates.

Keywords:
high-degree atrioventricular conduction abnormalities (HDCA)permanent pacemaker implantationright bundle branch blocktranscatheter aortic valve replacement

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Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiac Electrophysiology

Background:

  • Patients with pre-existing right bundle branch block (RBBB) undergoing transcatheter aortic valve replacement (TAVR) have a high risk of permanent pacemaker implantation (PPI).
  • Predictors of PPI in this specific patient subpopulation are not well-defined.

Purpose of the Study:

  • To identify predictors of permanent pacemaker implantation (PPI) in patients with baseline right bundle branch block (RBBB) undergoing transcatheter aortic valve replacement (TAVR).
  • To develop a risk stratification model for PPI in this patient group.

Main Methods:

  • Retrospective, multicenter study of 530 patients with baseline RBBB without pacemakers undergoing TAVR.
  • Primary endpoint was the incidence of PPI at 30 days.
  • Analysis of baseline characteristics, electrocardiographic parameters, and computed tomography findings to identify PPI predictors.

Main Results:

  • The incidence of PPI at 30 days was 42.2%.
  • Predictors associated with higher PPI rates included female sex, prolonged PR segment (> 240 ms), and use of self-expanding valves.
  • Valve-to-annulus oversizing > 10% and smaller left ventricular outflow tract were also associated with PPI.
  • A predictive model including female sex, PR > 240 ms, and self-expanding valves estimated PPI probability from 32.0% to 76.8%.

Conclusions:

  • In patients with baseline RBBB undergoing TAVR, PPI is more frequent in women, those with a prolonged PR segment, and those treated with self-expanding valves.
  • Risk stratification using these factors can help identify individuals at low or high risk for PPI.