The Canadian journal of cardiology · 2025
Pacemaker Risk Stratification in Patients With Pre-existing Right Bundle Branch Block Undergoing Transcatheter Aortic Valve Replacement.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
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Travieso Alejandro, Nuche Jorge, Tirado-Conte Gabriela, Cheema Asim N, Tamargo Maria, Muntané-Carol Guillem, Asmarats Lluis, Becerra-Muñoz Victor M, Valle Raquel Del, Rivero Fernando, Sanmartín Pena Juan Carlos, Cordón Clara Fernandez, Martínez-Selles Manuel, Muñoz-García Antonio J, Lopez Diego, Alonso-Briales Juan H, Gonzalo Nieves, Alfonso Fernando, Arzamendi Dabit, Gomez-Hospital Joan Antoni, Rodés-Cabau Josep, Nombela-Franco Luis
Аннотация
BACKGROUND: Patients with pre-existing right bundle branch block (RBBB) undergoing transcatheter aortic valve replacement (TAVR) face a high risk of permanent pacemaker implantation (PPI). However, additional predictors of PPI in this subpopulation are unknown.
METHODS: This retrospective, multicenter study enrolled 530 patients with baseline RBBB without pacemakers undergoing TAVR in native aortic valve stenosis. The primary endpoint was incidence of PPI at 30 days and predictors of the primary endpoint were used to determine PPI risk.
RESULTS: PPI occurred in 229 (42.2%) patients at 30 days. Female sex (49.5% in women vs 39.9% in men, P = 0.034), prolonged PR segment (61.1% if PR > 240 ms vs 42.2% if PR < 240 ms), and use of self-expanding valves (51.9% vs 36.2% in balloon-expandable valves, P = 0.001) were associated with higher rates of PPI at 30 days. Other electrocardiographic parameters (QRS duration or left fascicular hemiblock) were unrelated to PPI. Computed tomography subanalysis showed that valve-to-annulus oversizing > 10% and left ventricular outflow tract smaller than the annulus were significantly associated with PPI (P = 0.026 and P = 0.017, respectively). Multivariate analysis demonstrated that the best predictive model for PPI included female sex (odds ratio [OR] 1.38, P = 0.088), PR > 240 ms (OR 2.62, P = 0.008), and self-expanding valves (OR 1.95, P < 0.001). The probability estimation for PPI was 76.8% with all these factors present compared with 32.0% in the absence of these factors.
CONCLUSIONS: Among patients with baseline RBBB undergoing TAVR, PPI was more frequent in women with PR > 240 ms and treated with self-expanding valves. Appropriate risk stratification may help to detect low- or high-risk individuals of PPI.
METHODS: This retrospective, multicenter study enrolled 530 patients with baseline RBBB without pacemakers undergoing TAVR in native aortic valve stenosis. The primary endpoint was incidence of PPI at 30 days and predictors of the primary endpoint were used to determine PPI risk.
RESULTS: PPI occurred in 229 (42.2%) patients at 30 days. Female sex (49.5% in women vs 39.9% in men, P = 0.034), prolonged PR segment (61.1% if PR > 240 ms vs 42.2% if PR < 240 ms), and use of self-expanding valves (51.9% vs 36.2% in balloon-expandable valves, P = 0.001) were associated with higher rates of PPI at 30 days. Other electrocardiographic parameters (QRS duration or left fascicular hemiblock) were unrelated to PPI. Computed tomography subanalysis showed that valve-to-annulus oversizing > 10% and left ventricular outflow tract smaller than the annulus were significantly associated with PPI (P = 0.026 and P = 0.017, respectively). Multivariate analysis demonstrated that the best predictive model for PPI included female sex (odds ratio [OR] 1.38, P = 0.088), PR > 240 ms (OR 2.62, P = 0.008), and self-expanding valves (OR 1.95, P < 0.001). The probability estimation for PPI was 76.8% with all these factors present compared with 32.0% in the absence of these factors.
CONCLUSIONS: Among patients with baseline RBBB undergoing TAVR, PPI was more frequent in women with PR > 240 ms and treated with self-expanding valves. Appropriate risk stratification may help to detect low- or high-risk individuals of PPI.