Right bundle branch block is not associated with worse short- and mid-term outcome after transcatheter aortic valve implantation.
Journal
PloS one
ISSN: 1932-6203
Titre abrégé: PLoS One
Pays: United States
ID NLM: 101285081
Informations de publication
Date de publication:
2021
2021
Historique:
received:
12
02
2021
accepted:
03
06
2021
entrez:
16
6
2021
pubmed:
17
6
2021
medline:
16
11
2021
Statut:
epublish
Résumé
Transcatheter aortic valve implantation (TAVI) is the standard treatment option for patients with severe aortic stenosis (AS) at intermediate or high surgical risk. Preexisting right bundle branch block (RBBB) is a strong predictor of new pacemaker implantation (PPM) after TAVI, and previous data indicate a worse short- and long-term outcome of patients. The aim of this study was to investigate whether preexisting RBBB has an effect on the short- and mid-term outcome of patients undergoing TAVI in a German high-volume TAVI center. For the present retrospective analysis, a total of 1,891 patients with native severe AS with successful TAVI without preexisting PPM were included. The primary endpoint was all-cause mortality after 30 days and 12 months. Baseline RBBB was present in 190 (10.1%) of cases. Patients with preexisting RBBB had a considerably higher rate of new PPM after TAVI compared with patients without RBBB (87/190 [45.8%] vs. 219/1,701 [12.9%]; p<0.001). RBBB had no impact on all-cause mortality at 30 days (2.1% vs. 2.7%; p = 0.625) and at 12 months (14.4% vs. 13.6%; p = 0.765). Further stratification according to the presence of new PPM showed a difference in mid-term survival rates between the four groups, with the worst outcome for patients without RBBB and new PPM (log rank p = 0.024). However, no difference in mid-term cardiovascular survival was found. Preexisting RBBB is a common finding in patients with severe AS undergoing TAVI and is associated with considerably higher PPM rates but not with worse short- and mid-term outcome.
Sections du résumé
BACKGROUND
Transcatheter aortic valve implantation (TAVI) is the standard treatment option for patients with severe aortic stenosis (AS) at intermediate or high surgical risk. Preexisting right bundle branch block (RBBB) is a strong predictor of new pacemaker implantation (PPM) after TAVI, and previous data indicate a worse short- and long-term outcome of patients. The aim of this study was to investigate whether preexisting RBBB has an effect on the short- and mid-term outcome of patients undergoing TAVI in a German high-volume TAVI center.
METHODS
For the present retrospective analysis, a total of 1,891 patients with native severe AS with successful TAVI without preexisting PPM were included. The primary endpoint was all-cause mortality after 30 days and 12 months. Baseline RBBB was present in 190 (10.1%) of cases.
RESULTS
Patients with preexisting RBBB had a considerably higher rate of new PPM after TAVI compared with patients without RBBB (87/190 [45.8%] vs. 219/1,701 [12.9%]; p<0.001). RBBB had no impact on all-cause mortality at 30 days (2.1% vs. 2.7%; p = 0.625) and at 12 months (14.4% vs. 13.6%; p = 0.765). Further stratification according to the presence of new PPM showed a difference in mid-term survival rates between the four groups, with the worst outcome for patients without RBBB and new PPM (log rank p = 0.024). However, no difference in mid-term cardiovascular survival was found.
CONCLUSION
Preexisting RBBB is a common finding in patients with severe AS undergoing TAVI and is associated with considerably higher PPM rates but not with worse short- and mid-term outcome.
Identifiants
pubmed: 34133470
doi: 10.1371/journal.pone.0253332
pii: PONE-D-21-04878
pmc: PMC8208572
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e0253332Déclaration de conflit d'intérêts
MR received speaker fees from Abbott, CWH contributes to the advisory board of Medtronic, and WK received proctor/speaker honoraria from Abbott, Boston Scientific, Edwards Lifesciences, and Medtronic (other authors have nothing to disclose). This does not alter our adherence to PLOS ONE policies on sharing data and materials.
Références
Expert Rev Cardiovasc Ther. 2011 Jul;9(7):877-86
pubmed: 21809969
J Am Heart Assoc. 2017 Mar 3;6(3):
pubmed: 28258051
Eur J Cardiothorac Surg. 2012 Nov;42(5):S45-60
pubmed: 23026738
EuroIntervention. 2014 Feb;9(10):1142-50
pubmed: 24273252
N Engl J Med. 2017 Apr 6;376(14):1321-1331
pubmed: 28304219
Circ Cardiovasc Interv. 2016 May;9(5):e003635
pubmed: 27169577
Circulation. 1998 Dec 1;98(22):2494-500
pubmed: 9832497
JACC Cardiovasc Interv. 2016 Nov 14;9(21):2200-2209
pubmed: 27832845
Eur Heart J. 2018 Jun 1;39(21):2003-2013
pubmed: 29420704
Int J Cardiol. 2011 Jan 21;146(2):213-8
pubmed: 20202707
JACC Cardiovasc Interv. 2015 Jan;8(1 Pt A):60-9
pubmed: 25616819
N Engl J Med. 2010 Oct 21;363(17):1597-607
pubmed: 20961243
N Engl J Med. 2016 Apr 28;374(17):1609-20
pubmed: 27040324
JACC Cardiovasc Interv. 2019 Sep 23;12(18):1781-1793
pubmed: 31537278
Circulation. 2017 Sep 12;136(11):1049-1069
pubmed: 28893961
Eur Heart J. 2017 Sep 21;38(36):2739-2791
pubmed: 28886619
Clin Res Cardiol. 2018 Jan;107(1):60-69
pubmed: 28963581
Eur Heart J. 2013 Jan;34(2):138-46
pubmed: 22947613
J Interv Card Electrophysiol. 2012 Aug;34(2):189-95
pubmed: 22119855
Eur Heart J. 2013 Aug;34(29):2281-329
pubmed: 23801822
Ann Cardiothorac Surg. 2020 Nov;9(6):452-467
pubmed: 33312903
Am J Cardiol. 1996 Jun 1;77(14):1185-90
pubmed: 8651093
Circulation. 2009 Mar 17;119(10):e235-40
pubmed: 19228822
JACC Cardiovasc Interv. 2018 Feb 12;11(3):301-310
pubmed: 29413244
JACC Cardiovasc Interv. 2016 Nov 14;9(21):2210-2216
pubmed: 27832846
Circulation. 2014 Mar 18;129(11):1233-43
pubmed: 24370552
Clin Cardiol. 2015 Oct;38(10):604-13
pubmed: 26436874
J Am Coll Cardiol. 2018 Aug 7;72(6):689-692
pubmed: 30072000
JACC Cardiovasc Interv. 2016 Nov 14;9(21):2189-2199
pubmed: 27832844
JACC Cardiovasc Interv. 2016 Feb 8;9(3):244-254
pubmed: 26847116
Circulation. 2009 Aug 4;120(5):e29-30
pubmed: 19652115
JACC Cardiovasc Interv. 2017 Aug 14;10(15):1564-1574
pubmed: 28734885
Am J Cardiol. 2012 Nov 15;110(10):1489-95
pubmed: 22858187
Front Cardiovasc Med. 2018 Jul 03;5:85
pubmed: 30018969
N Engl J Med. 2011 Jun 9;364(23):2187-98
pubmed: 21639811
J Am Coll Cardiol. 2014 Jul 15;64(2):129-40
pubmed: 25011716
Nat Rev Cardiol. 2012 May 01;9(8):454-63
pubmed: 22547171