The impact of pre-existing right bundle brunch block on short and mid-term outcomes after transcatheter aortic valve implantation

Abstract Background We aimed to evaluate whether pre-existing right bundle brunch block (RBBB) is associated to higher risk of permanent pacemaker implantation (PPI) and short and mid-term all-cause mortality in patients (pts) undergoing transfemoral TAVI. Material and methods pts who underwent TAVI between 2016 and 2018 were included and those with prior PP, non-transfemoral approach and valve-in-valve procedures were excluded. ECG data before, immediately after the procedure, at day 3 post-TAVI and at discharge were collected, and continuous telemetry was recorded. We evaluated the rates of temporary and PPI during hospital stay and at 1-year follow-up (FUP), ventricular pacing rates in the first visit after PPI and all-cause mortality at 30-days, 3 and 6 months and 1-year after TAVI. Results and conclusions 220 pts were included. Baseline RBBB occurred in 18 pts (8,2%). Patients with RBBB presented higher baseline QRS duration (140,0 ± 16,9 ms vs. 107,9 ± 26,6 ms; P = 0,002), without differences in QRS duration immediately or at day-3 after TAVI (P > 0,05). High-degree atrioventricular block and complete atrioventricular block immediately after TAVI were more frequent in pts with RBBB (44,4% vs. 14,5%, P = 0,004). Patients with baseline RBBB presented significantly higher rates of PPI during hospital stay (55,6% vs. 20,0%; P = 0,002) and higher rates of PPI at 1-year FUP (58,8% vs. 21,4%; P = 0,002). The rates of ventricular pacing at the first visit in pts with RBBB was 75,0% (vs 47,2%; P = 0,139). No differences were found regarding 30-day, 3 and 6 months and 1-year FUP regarding all-cause mortality, between pts with and without RBBB.