title: Transcatheter Heart Valve Selection and Permanent Pacemaker Implantation in Patients With Pre-Existent Right Bundle Branch Block.
abstract: BACKGROUND
  Right bundle branch block is an established predictor for new conduction disturbances and need for a permanent pacemaker (PPM) after transcatheter aortic valve replacement. The aim of the study was to evaluate the absolute rates of transcatheter aortic valve replacement related PPM implantations in patients with pre-existent right bundle branch block and categorize for different transcatheter heart valves.
  
  
  RESULTS
  We pooled data on 306 transcatheter aortic valve replacement patients from 4 high-volume centers in Europe and selected those with right bundle branch block at baseline without a previously implanted PPM. Logistic regression was used to evaluate whether PPM rate differed among transcatheter heart valves after adjustment for confounders. Mean age was 83±7 years and 63% were male. Median Society of Thoracic Surgeons score was 6.3 (interquartile range, 4.1-10.2). The following transcatheter valve designs were used: Medtronic CoreValve (n=130; Medtronic, Minneapolis, MN); Edwards Sapien XT (ES-XT; n=124) and Edwards Sapien 3 (ES-3; n=32; Edwards Lifesciences, Irvine, CA); and Boston Scientific Lotus (n=20; Boston Scientific Corporation, Marlborough, MA). Overall permanent pacemaker implantation rate post-transcatheter aortic valve replacement was 41%, and per valve design: 75% with Lotus, 46% with CoreValve, 32% with ES-XT, and 34% with ES-3. The indication for PPM implantation was total atrioventricular block in 98% of the cases. Lotus was associated with a higher PPM rate than all other valves. PPM rate did not differ between ES-XT and ES-3. Ventricular paced rhythm at 30-day and 1-year follow-up was present in 81% at 89%, respectively.
  
  
  CONCLUSIONS
  Right bundle branch block at baseline is associated with a high incidence of PPM implantation for all transcatheter heart valves. PPM rate was highest for Lotus and lowest for ES-XT and ES-3. Pacemaker dependency remained high during follow-up.
authors.affiliation: Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Lennart
authors.initials: L
authors.lastname: van Gils
authors.affiliation: Clinique Pasteur, Toulouse, France.
authors.forename: Didier
authors.initials: D
authors.lastname: Tchetche
authors.affiliation: Hôpital Rangueil, Toulouse, France.
authors.forename: Thibault
authors.initials: T
authors.lastname: Lhermusier
authors.affiliation: University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Masieh
authors.initials: M
authors.lastname: Abawi
authors.affiliation: Clinique Pasteur, Toulouse, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Dumonteil
authors.affiliation: University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Ramón
authors.initials: R
authors.lastname: Rodriguez Olivares
authors.affiliation: Clinique Pasteur, Toulouse, France.
authors.forename: Javier
authors.initials: J
authors.lastname: Molina-Martin de Nicolas
authors.affiliation: University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Pieter R
authors.initials: PR
authors.lastname: Stella
authors.affiliation: Hôpital Rangueil, Toulouse, France.
authors.forename: Didier
authors.initials: D
authors.lastname: Carrié
authors.affiliation: Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Peter P
authors.initials: PP
authors.lastname: De Jaegere
authors.affiliation: Erasmus Medical Center, Rotterdam, The Netherlands n.vanmieghem@erasmusmc.nl.
authors.forename: Nicolas M
authors.initials: NM
authors.lastname: Van Mieghem
mesh_terms: D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000150:complications / Q000601:surgery*; D002037:Bundle-Branch Block / Q000150:complications / Q000628:therapy*; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D061847:Hospitals, High-Volume / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D008297:Male; D010138:Pacemaker, Artificial; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects*
keywords: aortic stenosis; bundle‐branch block; pacemaker; predictors; right bundle branch block; transcatheter aortic valve implantation; transcatheter aortic valve replacement