Impact of the Approach Site on Conduction Disturbance in Right Ventricular Biopsy
Shohei Yoshida1, Hayato Tada1, Yasuaki Takeji1
1Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Science.
Insights
The transjugular approach for right ventricular endomyocardial biopsy significantly reduces the risk of complete right bundle branch block (CRBBB) compared to the transfemoral method. This venous access technique is a safer option for patients susceptible to heart conduction disturbances.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Procedures
Background:
- Right ventricular endomyocardial biopsy is associated with conduction disturbances, notably complete right bundle branch block (CRBBB).
- The influence of the venous access site on CRBBB incidence after biopsy is not well-defined.
Purpose of the Study:
- To compare the incidence of CRBBB following right ventricular endomyocardial biopsy using transfemoral versus transjugular venous access.
- To evaluate the safety and efficacy of different venous access routes in preventing CRBBB.
Main Methods:
- A retrospective analysis of 274 patients undergoing right ventricular endomyocardial biopsy.
- Comparison of CRBBB rates between transfemoral and transjugular venous access groups.
- Statistical analysis to determine the independent impact of the transjugular approach on CRBBB risk.
Main Results:
- CRBBB occurred significantly more often with the transfemoral approach (29.2%) than the transjugular approach (6.7%) (P<0.001).
- The transjugular approach was an independent protective factor against CRBBB (odds ratio 0.17, P<0.001).
- Sustained CRBBB was also less frequent with the transjugular route (1.1% vs. 8.3%, P=0.007), with no major complications observed.
Conclusions:
- The transjugular approach is associated with a lower risk of CRBBB after right ventricular endomyocardial biopsy.
- This venous access method offers a safer alternative for patients at risk of complete atrioventricular block.
Background:
Right ventricular endomyocardial biopsy may cause conduction disturbances, particularly complete right bundle branch block (CRBBB); however, the impact of using the venous access site remains unclear.
Methods And Results:
In 274 patients, CRBBB occurred more frequently with the transfemoral than with the transjugular approach (29.2% vs. 6.7%, P<0.001). The transjugular approach independently reduced CRBBB risk (odds ratio 0.17, P<0.001). Sustained CRBBB was also less frequent (8.3% vs. 1.1%, P=0.007). Major complications, including stroke, pacemaker implantation, and death, were absent.
Conclusions:
The transjugular approach reduces CRBBB risk and is a safer option for patients at risk of complete atrioventricular block.
