BACKGROUND:The incidence and prognosis of right bundle branch block (RBBB) following transcatheter aortic valve replacement (TAVR) are unknown. Hence, we sought to characterize the incidence of post-TAVR RBBB and determine associated risks of permanent pacemaker (PPM) implantation and mortality.METHODS:All patients 18 years and above without preexisting RBBB or PPM who underwent TAVR at US Mayo Clinic sites and Mayo Clinic Health Systems from June 2010 to May 2021 were evaluated. Post-TAVR RBBB was defined as new-onset RBBB in the postimplantation period. The risks of PPM implantation (within 90 days) and mortality following TAVR were compared for patients with and without post-TAVR RBBB using Kaplan-Meier analysis and Cox proportional hazards modeling. The risks of PPM implantation (within 90 days) and mortality following TAVR were compared for patients with and without post-TAVR RBBB using Kaplan-Meier analysis and Cox proportional hazards modeling.RESULTS:Of 1992 patients, 15 (0.75%) experienced new RBBB post-TAVR. There was a higher degree of valve oversizing among patients with new RBBB post-TAVR versus those without (17.9% versus 10.0%; P=0.034). Ten patients (66.7%) with post-TAVR RBBB experienced high-grade atrioventricular block and underwent PPM implantation (median 1 day; Q1, 0.2 and Q3, 4), compared with 268/1977 (13.6%) without RBBB. Following propensity score adjustment for covariates (age, sex, balloon-expandable valve, annulus diameter, and valve oversizing), post-TAVR RBBB was significantly associated with PPM implantation (hazard ratio, 8.36 [95% CI, 4.19–16.7]; P<0.001). No statistically significant increase in mortality was seen with post-TAVR RBBB (hazard ratio, 0.83 [95% CI, 0.33–2.11]; P=0.69), adjusting for age and sex.CONCLUSIONS:Although infrequent, post-TAVR RBBB was associated with elevated PPM implantation risk. The mechanisms for its development and its clinical prognosis require further study.

中文翻译：

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经导管主动脉瓣置换术后新发右束支传导阻滞的发生率和结果

背景：经导管主动脉瓣置换术（TAVR）后右束支传导阻滞（RBBB）的发生率和预后尚不清楚。因此，我们试图描述 TAVR 后 RBBB 的发生率，并确定永久起搏器 (PPM) 植入和死亡的相关风险。 方法：所有 18 岁及以上、先前没有 RBBB 或 PPM 且在美国梅奥诊所和 Mayo 接受 TAVR 的患者对 2010 年 6 月至 2021 年 5 月的诊所卫生系统进行了评估。TAVR 后 RBBB 定义为植入后新发 RBBB。使用 Kaplan-Meier 分析和 Cox 比例风险模型，对有和没有 TAVR 后 RBBB 的患者进行 TAVR 后 PPM 植入（90 天内）的风险和死亡率进行比较。使用 Kaplan-Meier 分析和 Cox 比例风险模型，比较 TAVR 后有和没有 RBBB 的患者的 PPM 植入风险（90 天内）和死亡率。 结果：在 1992 名患者中，15 名 (0.75%) 经历了新的 RBBB TAVR 后。TAVR 后接受新 RBBB 的患者与未接受 RBBB 的患者相比，瓣膜尺寸过大的程度更高（17.9% vs 10.0%；P = 0.034）。TAVR 后 RBBB 的 10 名患者 (66.7%) 经历了高度房室传导阻滞并接受了 PPM 植入（中位 1 天；Q1，0.2 和 Q3，4），而没有 RBBB 的患者为 268/1977 (13.6%)。对协变量（年龄、性别、球囊扩张瓣膜、瓣环直径和瓣膜尺寸过大）进行倾向评分调整后，TAVR 后 RBBB 与 PPM 植入显着相关（风险比，8.36 [95% CI，4.19–16.7]；P <0.001）。经年龄和性别调整后，TAVR RBBB 后死亡率未见统计学显着增加（风险比为 0.83 [95% CI，0.33–2.11]；P = 0.69）。结论：虽然不常见，但 TAVR RBBB 相关PPM 植入风险升高。其发生机制及临床预后尚需进一步研究。