Related Experiment Video
Updated: Aug 10, 2026
Upper-extremity Approach for Secondary Access in Transfemoral Transcatheter Aortic Valve Implantation
Published on: August 8, 2025
Pacemaker Implantation in Patients With Pre-Existing Bundle Branch Block Undergoing Balloon-Expandable Transcatheter
Judah Rajendran1, Shivabalan Kathavarayan Ramu1, Carl Ammoury1
1Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio.
Background:
The primary objective of this study was to compare permanent pacemaker (PPM) implantation rates following balloon-expandable transcatheter aortic valve replacement (TAVR) between patients with pre-existing right bundle branch block (RBBB) versus left bundle branch block (LBBB). Secondary objectives were to assess long-term clinical outcomes according to baseline conduction status and post-TAVR PPM implantation and identify independent predictors of PPM implantation.
Methods:
This retrospective study included 380 patients with pre-existing RBBB (n = 269) and LBBB (n = 111) who underwent balloon-expandable TAVR between 2016 and 2020, excluding those with prior pacemakers or implantable cardioverter defibrillators.
Results:
Within 30 days following TAVR, PPM implantation was significantly more frequent in patients with preexisting RBBB compared with LBBB (18.59 vs. 7.21%, p = 0.003), whereas early mortality remained low and similar between groups. Patients with RBBB exhibited larger annular dimensions, greater annular calcium burden, and a narrower membranous septum angle. Over long-term 2-year follow-up, there were no significant differences in all-cause mortality or heart failure hospitalization between RBBB and LBBB patients, irrespective of post-TAVR PPM implantation status. On multivariable logistic regression, baseline RBBB (odds ratio [OR] 3.56; 95% CI 1.01-12.58) and prior atrial fibrillation/flutter (OR 4.13; 95% CI 1.63-10.45) were independently associated with increased 30-day PPM risk, whereas deeper right-sided membranous septum implantation depth was associated with lower PPM risk (OR 0.90; 95% CI 0.81-0.99).
Conclusions:
Patients with preexisting RBBB undergoing balloon-expandable TAVR had a significantly higher and earlier rate of PPM implantation compared to LBBB patients, with no differences in outcomes irrespective of BBB and PPM implantation status. Atrial fibrillation/flutter and RBBB were associated with an increased risk of 30-day PPM implantation, although the risk is acceptable with higher valve implantation.
