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9 Transcatheter aortic valve implantation in patients with right bundle branch block: should prophylactic pacing be undertaken?
  1. Chris Pavitt1,
  2. Mohammad Waleed2,
  3. Sandeep Arunothayaraj2,
  4. Michael Michail2,
  5. James Cockburn2,
  6. Adam de Belder2,
  7. David Hildick-Smith2
  1. 1Sussex Cardiac Centre, Sussex Cardiac Centre, Brighton, Royal Sussex County Hospital, ESX BN2 5BE, United Kingdom
  2. 2Sussex Cardiac Centre


Introduction In patients undergoing transcatheter aortic valve implantation (TAVI), right bundle branch block (RBBB) is a strong predictor of the development of high-grade AV block (AVB). We assessed mortality and length of hospital stay in patients with RBBB undergoing TAVI according to whether they had had pre-procedural permanent pacemaker implantation.

Methods and Results Consecutive patients undergoing TAVI for severe aortic stenosis at a single centre between 2009 – 2021 were screened for the presence of RBBB and formed the study cohort. The endpoints were mortality at 30 days and 5 years, and in-hospital length of stay. 1684 patients (median age 83 [79 – 87] years; 32% female) were screened, of whom 121 (7.2%) had RBBB. 41 (33.9%) patients received a prophylactic PPM by clinical preference. Of the remaining 80, 45 (56%) patients received a PPM after TAVI. Baseline demographic and procedural characteristics were similar. Among those patients in sinus rhythm who had a prophylactic PPM, the PR interval was longer than in those who did not receive a prophylactic pacemaker (200 ms [170 – 228] vs. 175 ms [158 – 196]; p=0.05). Similarly, the QRS duration was longer (140 ms [126 – 156] vs. 131 ms [120 – 142]; p=0.01). There was numerically but not statistically more left anterior hemi-block (24 [62%] vs. 29 [45%]; p=0.10). All-cause mortality was similar at 5 years with death in 17 patients (41.4%) in the prophylactic PPM group vs. 27 (33.8%) in the no prophylactic PPM group; hazard ratio 1.27 (95% CI 0.69 to 2.33; p=0.44; Figure 1). In the no prophylactic PPM group 16 (35.6%) deaths occurred in those receiving PPM after TAVI and 11 (31.4%) in those not receiving PPM; hazard ratio 0.95 (95% CI 0.43 to 2.09; p=0.90). 30-day all-cause mortality was also similar with 2 deaths (5.3%) occurring in the prophylactic group vs. 5 deaths (6%) in those without a prophylactic PPM, 3 (8.6%) of which were in those not receiving PPM and 2 (4.4%) receiving PPM after TAVI. There was a trend to a reduced hospital length of stay in those receiving prophylactic PPM compared to those who either received a post TAVI PPM or who were discharged without PPM (2.5 (1.6) days vs. 4.0 (4.8) days, respectively; p = 0.08). When comparing the prophylactic PPM group to those who received PPM after TAVI, there was a statistically significant reduction in length of stay (2.5 [1.6] vs. 4.3 [4.5] days, respectively; p=0.02; Figure 2). Two patients in the prophylactic PPM group developed a pocket haematoma managed non-operatively.

Abstract 9 Table 1

Comparison of incidence of peri-operative embolic cerebral microinfarction as per DWI-MRI following MVR and MVr

Abstract 9 Table 2

Impact of peri-operative acute cerebral microinfarction on mean change in health-related quality of life at 6 months after mitral valve surgery

Conclusions Over half of patients with RBBB undergoing TAVI require a pacemaker after their valve implant for high-grade AV block. A prophylactic pacing strategy in this high-risk cohort is safe and reduces length of hospital stay.

Conflict of Interest None

  • TAVI
  • Right-Bundle Branch Block
  • Pacemaker

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