Predictors and Prognosis of Right Bundle Branch Block Following Heart Transplantation: A Systematic Review and
Naydeen Mostafa1, Omar Almaadawy2, Ahmed Elshahat3
1Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Background:
Right bundle branch block (RBBB) has a high prevalence among heart transplant recipients and could influence outcomes. Crucially, the predictors of RBBB development after heart transplantation are not well-established. Our study aims to evaluate the preoperative predictors and outcomes of RBBB following heart transplantation.
Methods:
PubMed, Scopus, Web of Science, and Cochrane Library were searched up to November 15, 2024, to identify studies comparing heart transplant recipients with RBBB and without RBBB. Random-effects models were used to estimate the pooled mean difference (MD) and risk ratios (RRs) with 95% confidence intervals (95% CIs).
Results:
Nine studies incorporating 1507 patients were included. Patients who developed RBBB had higher graft ischemia time [MD: 10.0; 95% CI: 2.00-17.91; p = 0.01] and pulmonary vascular resistance (PVR) (MD: 0.44; 95% CI: 0.21-0.68; p < 0.001). There was no significant difference between RBBB and non-RBBB patients in terms of pulmonary artery pressure (MD: 1.83; 95% CI: -0.86-4.53; p = 0.18) or donor age (MD: 1.51; 95% CI: -0.30- 3.31; p = 0.10). There was no significant difference in the prognosis of RBBB patients in terms of acute rejection (RR: 1.06; 95% CI: 0.70-1.61; p = 0.78), chronic rejection (RR: 0.92; 95% CI: 0.60-1.41; p = 0.70), or mortality (RR: 1.87; 95% CI: 0.81-4.31; p = 0.14).
Conclusion:
Despite the association of RBBB with graft ischemia time and PVR, post-transplant RBBB had no significant impact on mortality or graft rejection. Further research focusing on the identification period and applied definition of RBBB is recommended.
