Incidence and Outcomes of New-Onset Right Bundle Branch Block Following Transcatheter Aortic Valve Replacement.

IF 9.1 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Circulation. Arrhythmia and electrophysiology Pub Date : 2024-02-01 Epub Date: 2024-01-30 DOI:10.1161/CIRCEP.123.012377

Nicholas Y Tan, Demilade Adedinsewo, Abdallah El Sabbagh, Ahmed F Sayed Ahmed, Andrea Carolina Morales-Lara, Mikolaj Wieczorek, Malini Madhavan, Siva K Mulpuru, Abhishek J Deshmukh, Samuel J Asirvatham, Mackram F Eleid, Paul A Friedman, Yong-Mei Cha, Ammar M Killu

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Abstract

Background: The incidence and prognosis of right bundle branch block (RBBB) following transcatheter aortic valve replacement (TAVR) are unknown. Hence, we sought to characterize the incidence of post-TAVR RBBB and determine associated risks of permanent pacemaker (PPM) implantation and mortality.

Methods: All patients 18 years and above without preexisting RBBB or PPM who underwent TAVR at US Mayo Clinic sites and Mayo Clinic Health Systems from June 2010 to May 2021 were evaluated. Post-TAVR RBBB was defined as new-onset RBBB in the postimplantation period. The risks of PPM implantation (within 90 days) and mortality following TAVR were compared for patients with and without post-TAVR RBBB using Kaplan-Meier analysis and Cox proportional hazards modeling. The risks of PPM implantation (within 90 days) and mortality following TAVR were compared for patients with and without post-TAVR RBBB using Kaplan-Meier analysis and Cox proportional hazards modeling.

Results: Of 1992 patients, 15 (0.75%) experienced new RBBB post-TAVR. There was a higher degree of valve oversizing among patients with new RBBB post-TAVR versus those without (17.9% versus 10.0%; P=0.034). Ten patients (66.7%) with post-TAVR RBBB experienced high-grade atrioventricular block and underwent PPM implantation (median 1 day; Q1, 0.2 and Q3, 4), compared with 268/1977 (13.6%) without RBBB. Following propensity score adjustment for covariates (age, sex, balloon-expandable valve, annulus diameter, and valve oversizing), post-TAVR RBBB was significantly associated with PPM implantation (hazard ratio, 8.36 [95% CI, 4.19-16.7]; P<0.001). No statistically significant increase in mortality was seen with post-TAVR RBBB (hazard ratio, 0.83 [95% CI, 0.33-2.11]; P=0.69), adjusting for age and sex.

Conclusions: Although infrequent, post-TAVR RBBB was associated with elevated PPM implantation risk. The mechanisms for its development and its clinical prognosis require further study.

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经导管主动脉瓣置换术后新发右束支传导阻滞的发生率和预后。

背景：经导管主动脉瓣置换术（TAVR）后右束支传导阻滞（RBBB）的发生率和预后尚不清楚。因此，我们试图描述经导管主动脉瓣置换术后 RBBB 的发生率，并确定永久起搏器（PPM）植入和死亡率的相关风险：方法：我们对 2010 年 6 月至 2021 年 5 月期间在美国梅奥诊所和梅奥诊所医疗系统接受 TAVR 的所有 18 岁及以上无 RBBB 或 PPM 的患者进行了评估。TAVR后RBBB定义为植入术后新发的RBBB。采用 Kaplan-Meier 分析和 Cox 比例危险模型比较了有和没有 TAVR 后 RBBB 的患者在 TAVR 后的 PPM 植入风险（90 天内）和死亡率。TAVR后RBBB定义为植入后新发的RBBB。使用Kaplan-Meier分析和Cox比例危险模型比较了有TAVR后RBBB和没有TAVR后RBBB患者的PPM植入风险（90天内）和TAVR后死亡率：1992名患者中，15人（0.75%）在TAVR后出现新的RBBB。TAVR术后出现新RBBB的患者与未出现新RBBB的患者相比，瓣膜过大的比例更高（17.9%对10.0%；P=0.034）。TAVR后RBBB患者中有10人（66.7%）出现高级别房室传导阻滞并接受了PPM植入术（中位数为1天；第一季度为0.2天，第三季度为4天），而无RBBB的患者有268/1977人（13.6%）。在对协变量（年龄、性别、球囊扩张瓣膜、瓣环直径和瓣膜过大）进行倾向评分调整后，TAVR后RBBB与PPM植入显著相关（危险比为8.36 [95% CI, 4.19-16.7]；PP=0.69），调整了年龄和性别：TAVR后RBBB虽然不常见，但与PPM植入风险升高有关。结论：TAVR术后RBBB虽然不常见，但与PPM植入风险升高有关，其发生机制和临床预后需要进一步研究。

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来源期刊

Circulation. Arrhythmia and electrophysiology 医学-心血管系统

CiteScore

13.70

自引率

4.80%

发文量

187

审稿时长

4-8 weeks

期刊介绍： Circulation: Arrhythmia and Electrophysiology is a journal dedicated to the study and application of clinical cardiac electrophysiology. It covers a wide range of topics including the diagnosis and treatment of cardiac arrhythmias, as well as research in this field. The journal accepts various types of studies, including observational research, clinical trials, epidemiological studies, and advancements in translational research.