This study aimed to explore contemporary in-hospital outcomes and trends of transcatheter
aortic valve implantation (TAVI) outcomes in patients with baseline right bundle branch
block (RBBB) using data collected from a nationwide sample. Using the National Inpatient
Sample, we identified patients hospitalized for an index TAVI procedure from 2016
to 2019. Primary outcomes included in-hospital all-cause mortality, complete heart
block, and permanent pacemaker (PPM) implantation. A total of 199,895 hospitalizations
for TAVI were identified. RBBB was present in 10,495 cases (5.3%). Patients with RBBB
were older (median age 81 vs 80 years, p <0.001) and less likely to be female (35%
vs 47.4%, p <0.001). After adjusting for differences in baseline characteristics and
elective versus nonelective admission, patients with RBBB had a higher incidence of
complete heart block (adjusted odds ratio [aOR] 4.77, confidence interval [CI] 4.55
to 5.01, p <0.001) and PPM implantation (aOR 4.15, CI 3.95 to 4.35, p <0.001) and
no difference in-hospital mortality rate (aOR 0.85, CI 0.69 to 1.05, p = 0.137). Between
2016 and 2019, there was a 3.5% and 2.9% decrease in in-hospital PPM implantation
in patients with and without RBBB, respectively. In conclusion, from 2016 to 2019,
the rate of in-hospital PPM implantation decreased during index TAVI hospitalization
in both patients with and without RBBB. However, in those with baseline RBBB, complete
heart block complication rates requiring PPM implantation remain relatively high.
Further research and advances are needed to continue to reduce complication rates
and the need for PPM implantation.
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Article info
Publication history
Published online: November 26, 2022
Received in revised form:
October 21,
2022
Received:
June 9,
2022
Footnotes
Funding: none.
Identification
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© 2022 Elsevier Inc. All rights reserved.
