The utility of prophylactic pacemaker implantation in right bundle branch block patients pre-transcatheter aortic valve implantation

Oholi Tovia-Brodie*, Sevan Letourneau-Shesaf, Aviram Hochstadt, Arie Steinvil, Raphael Rosso, Ariel Finkelstein, Yoav Michowitz

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Patients with right bundle branch block (RBBB) prior to transcatheter aortic valve implantation (TAVI) are at high risk for immediate post-procedural heart block and long-term mortality when discharged without a pacemaker. Objectives: To test whether prophylactic permanent pacemaker implantation (PPI) is beneficial. Methods: Of 795 consecutive patients who underwent TAVI, 90 patients had baseline RBBB. We compared characteristics and outcomes of the prophylactic PPI with post-TAVI PPI. Need for pacing was defined as greater than 1% ventricular pacing. Results: Forty patients with RBBB received a prophylactic PPI (group 1), and in 50 the decision was based on standard post-procedural indications (group 2). There were no significant differences in clinical baseline characteristics. One patient developed a tamponade after a PPI post-TAVI. A trend toward shorter hospitalization duration in group 1 patients was observed (P = 0.06). On long-term follow-up of 848 ± 56 days, no differences were found in overall survival (P = 0.77), the composite event-free survival of both mortality and hospitalizations (P = 0.66), or mortality and syncope (P = 0.65). On multivariate analysis, independent predictors of the need for pacing included baseline PR interval increase of 10 ms (odds ratio [OR] 1.21 per 10 ms increment 95% confidence interval [95%CI] 1.02-1.44, P = 0.028), and the use of new generation valves (OR 3.92 95%CI 1.23-12.46, P = 0.023). Conclusions: In patients with baseline pre-TAVI RBBB, no outcome differences were found with prophylactic PPI. On multivariate analysis, predictors of the need for pacing included baseline long PR interval, and the use of newer generation valves.

Original languageEnglish
Pages (from-to)790-795
Number of pages6
JournalIsrael Medical Association Journal
Volume21
Issue number12
StatePublished - 2019

Keywords

  • Conduction disturbances
  • Pacemaker
  • Prophylactic
  • Right bundle branch block (RBBB)
  • Transcatheter aortic valve implantation (TAVI)

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