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Related Concept Videos

Cardiac Catheterization II: Right Heart Catheterization01:21

Cardiac Catheterization II: Right Heart Catheterization

165
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

Aortic Regurgitation I: Introduction

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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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Aortic Regurgitation III: Medical Management01:25

Aortic Regurgitation III: Medical Management

43
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...
43

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Related Experiment Video

Updated: Sep 12, 2025

Upper-extremity Approach for Secondary Access in Transfemoral Transcatheter Aortic Valve Implantation
06:02

Upper-extremity Approach for Secondary Access in Transfemoral Transcatheter Aortic Valve Implantation

Published on: August 8, 2025

185

New-Onset RBBB After Transcatheter Aortic Valve Replacement: Incidence and Risk Factors for Permanent Pacemaker

Yoav Michowitz1, Oren Yagel2, Maayan Shrem1

  • 1Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Jerusalem, Israel; Hadassah Hebrew University, Jerusalem, Israel.

JACC. Clinical Electrophysiology
|August 6, 2025
PubMed
Summary

Right bundle branch block (RBBB) after transcatheter aortic valve replacement (TAVR) is rare but can lead to conduction system deterioration. Early identification of RBBB and specific electrocardiogram changes can help predict the need for permanent pacemaker implantation.

Keywords:
AVBPPIRBBBTAVRatrioventricular conduction blockpermanent pacemaker implantationright bundle branch blocktranscatheter aortic valve replacement

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Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Electrophysiology

Background:

  • Right bundle branch block (RBBB) is an uncommon complication following transcatheter aortic valve replacement (TAVR).
  • Understanding its incidence and predictors is crucial for patient management.

Purpose of the Study:

  • To determine the incidence of new-onset RBBB after TAVR.
  • To identify risk factors for permanent pacemaker implantation (PPI) in these patients.

Main Methods:

  • Retrospective analysis of 7,782 TAVR procedures across 7 Israeli centers.
  • Electrocardiogram monitoring before and after TAVR.
  • Definition of absolute pacing indication (API) for high-grade atrioventricular block or alternating bundle branch block.

Main Results:

  • An incidence of 5.3 per 1,000 TAVR procedures for new-onset RBBB was observed.
  • Nearly half of patients (46.3%) required PPI within one year, with 36.6% having API.
  • Post-TAVR PR interval ≥228 ms and Δ PR ≥24 ms showed predictive value for API.

Conclusions:

  • Post-TAVR RBBB is rare but associated with significant conduction system deterioration and high PPI rates, often within the first week.
  • PR interval changes (≥230 ms) and PR drop (≥24 ms) can help stratify patients at risk for progressive conduction worsening.