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JACC Cardiovasc Interv. 2017 Aug 14;10(15):1564-1574. doi: 10.1016/j.jcin.2017.05.030. Epub 2017 Jul 19.

Clinical Impact of Baseline Right Bundle Branch Block in Patients Undergoing Transcatheter Aortic Valve Replacement.

Author information

1
Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada.
2
St-Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
3
Hôpital Charles Nicolle, Université de Rouen, Inserm UMR1096, Rouen, France.
4
Hospital Clinico Universitario Virgen de la Victoria, Universidad de Málaga, Málaga, Spain.
5
Assistance Publique-Hôpitaux de Paris, Hôpital Bichat-Claude Bernard, Paris, France.
6
Ospedale Ferrarotto, Università di Catania, Catania, Italy.
7
Hospital Universitario Clínico San Carlos, Madrid, Spain.
8
University Hospital of Zurich, University of Zurich, Zurich, Switzerland.
9
Hospital Universitario Central de Asturias, Universidad de Oviedo, Oviedo, Spain.
10
University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
11
Clìnica de Occidente de Cali, Valle del Cauca, Colombia.
12
Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain.
13
St-Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
14
Hospital Clínico Universitario de Valladolid, Valladolid, Spain.
15
Hospital Israelita Albert Einstein, São Paulo, Brazil.
16
Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil.
17
Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil.
18
Instituto de Cardiologia do Rio Grande do Sul, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil.
19
St-Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada; Ospedale Ferrarotto, Università di Catania, Catania, Italy.
20
Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada. Electronic address: josep.rodes@criucpq.ulaval.ca.

Abstract

OBJECTIVES:

This study sought to assess the influence of baseline right bundle branch block (RBBB) on all-cause and cardiovascular mortality as well as sudden cardiac death (SCD) among patients undergoing transcatheter aortic valve replacement (TAVR).

BACKGROUND:

Few data exist regarding the late clinical impact of pre-existing RBBB in TAVR recipients.

METHODS:

A total of 3,527 patients (mean age 82 ± 8 years, 50.1% men) were evaluated according to the presence of RBBB on baseline electrocardiography. Intraventricular conduction abnormalities were classified according to the American Heart Association, American College of Cardiology Foundation, and Heart Rhythm Society recommendations for standardization and interpretation of the electrocardiogram. TAVR complications and causes of death were defined according to Valve Academic Research Consortium 2 definitions.

RESULTS:

RBBB was present on baseline electrocardiography in 362 patients (10.3%) and associated with higher 30-day rates of permanent pacemaker implantation (PPI) (40.1% vs. 13.5%; p < 0.001) and death (10.2% vs. 6.9%; p = 0.024). At a mean follow-up of 20 ± 18 months, pre-existing RBBB was independently associated with all-cause mortality (hazard ratio [HR]: 1.31; 95% confidence interval [CI]: 1.06 to 1.63; p = 0.014) and cardiovascular mortality (HR: 1.45; 95% CI: 1.11 to 1.89; p = 0.006) but not with SCD (HR: 0.71; 95% CI: 0.22 to 2.32; p = 0.57). Patients with pre-existing RBBB and without PPI at discharge from the index hospitalization had the highest 2-year risk for cardiovascular death (27.8%; 95% CI: 20.9% to 36.1%; log-rank p = 0.007). In a subanalysis of 1,245 patients without PPI at discharge from the index hospitalization and with complete follow-up regarding the need for PPI, pre-existing RBBB was independently associated with the composite of SCD and PPI (HR: 2.68; 95% CI: 1.16 to 6.17; p = 0.023).

CONCLUSIONS:

Pre-existing RBBB was found in 10% of TAVR recipients and was associated with poorer clinical outcomes. Patients with baseline RBBB without permanent pacemakers at hospital discharge may be at especially high risk for high-degree atrioventricular block and/or SCD during follow-up. Future studies should evaluate strategies aimed at the early detection of patients at risk for late development of high-degree atrioventricular block.

KEYWORDS:

outcomes; permanent pacemaker implantation; right bundle branch block; sudden cardiac death; transcatheter aortic valve replacement

PMID:
28734885
DOI:
10.1016/j.jcin.2017.05.030
[Indexed for MEDLINE]
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