Pre-Existing Right Bundle Branch Block Increases Risk for Death After Transcatheter Aortic Valve Replacement With a Balloon-Expandable Valve.
The aim of this study was to determine the impact of pre-existing right bundle branch block (RBBB) on clinical outcomes after transcatheter aortic valve replacement (TAVR).



The impact of pre-existing RBBB on clinical outcomes after TAVR is unknown.



Between October 2013 and August 2015, 749 patients undergoing TAVR using the Edwards SAPIEN XT prosthesis were prospectively enrolled in the OCEAN-TAVI (Optimized Transcatheter Valvular Intervention) registry from 8 Japanese centers. Electrocardiograms were obtained at baseline. After the procedure, follow-up outpatient visits or telephone interviews were conducted at 30 days, 6 months, and yearly.



A total of 102 patients (13.6%) had pre-existing RBBB. The incidence of new pacemaker implantation was significantly higher in the RBBB group (17.6% vs. 2.9%; p < 0.01). The Kaplan-Meier analysis revealed that cardiovascular survival probability was significantly lower in the RBBB group than the no-RBBB group (log-rank p < 0.01). Patients with RBBB and without pacemakers were at higher risk for cardiovascular mortality in the early phase after discharge, and patients with RBBB and pacemakers had higher cardiovascular mortality at mid-term follow-up (log-rank p = 0.01). A multivariate Cox regression model indicated that pre-existing RBBB (hazard ratio: 2.59; 95% confidence interval: 1.15 to 5.85; p < 0.01) was an independent predictor of cardiovascular mortality.



Patients with RBBB demonstrated an increased risk for cardiovascular mortality after TAVR, and patients with RBBB and without pacemakers were at higher risk for cardiac death early after discharge. Patients with prior RBBB should be carefully monitored after undergoing TAVR.
Teikyo University School of Medicine, Tokyo, Japan. Electronic address: yusuke0831@gmail.com.
Yusuke
Y
Watanabe
Teikyo University School of Medicine, Tokyo, Japan.
Ken
K
Kozuma
Teikyo University School of Medicine, Tokyo, Japan.
Hirofumi
H
Hioki
Teikyo University School of Medicine, Tokyo, Japan.
Hideyuki
H
Kawashima
Teikyo University School of Medicine, Tokyo, Japan.
Yugo
Y
Nara
Teikyo University School of Medicine, Tokyo, Japan.
Akihisa
A
Kataoka
Teikyo University School of Medicine, Tokyo, Japan.
Fukuko
F
Nagura
Teikyo University School of Medicine, Tokyo, Japan.
Makoto
M
Nakashima
Kokura Memorial Hospital, Fukuoka, Japan.
Shinichi
S
Shirai
Sendai Kousei Hospital, Miyagi, Japan.
Norio
N
Tada
Saiseikai Yokohama-City Eastern Hospital, Kanagawa, Japan.
Motoharu
M
Araki
New Tokyo Hospital, Chiba, Japan.
Kensuke
K
Takagi
Shonan Kamakura General Hospital, Kanagawa, Japan.
Futoshi
F
Yamanaka
Toyohashi Heart Center, Aichi, Japan; Nagoya Heart Center, Aichi, Japan.
Masanori
M
Yamamoto
Keio University School of Medicine, Tokyo, Japan.
Kentaro
K
Hayashida
D000369:Aged, 80 and over; D001021:Aortic Valve / Q000503:physiopathology / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000150:complications / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D063126:Balloon Valvuloplasty / Q000009:adverse effects / Q000401:mortality*; D002037:Bundle-Branch Block / Q000150:complications / Q000401:mortality* / Q000503:physiopathology / Q000628:therapy; D002304:Cardiac Pacing, Artificial / Q000009:adverse effects; D016009:Chi-Square Distribution; D005260:Female; D006350:Heart Valve Prosthesis; D006801:Humans; D007564:Japan; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D010138:Pacemaker, Artificial; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011474:Prosthesis Design; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality*; D016896:Treatment Outcome
RBBB; cardiac death; transcatheter aortic valve replacement