Right bundle branch block strong predictor of pacemaker implantation in TAVR
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Left and right bundle branch blocks are associated with increased rates of pacemaker implantation after undergoing transcatheter aortic valve replacement, with right bundle branch being a much stronger predictor, data show.
“Our nationwide study shows that need for pacemaker implantation remains a major complication after TAVR in patients with a bundle branch block,” Salman Zahid, MD, a resident physician at Rochester General Hospital in New York, told Healio. “However, new pacemaker implantation rates have decreased significantly over time along with reduced length of stay and cost of hospitalization.”
Zahid and colleagues analyzed data on trends, predictors and outcomes of TAVR in patients with bundle branch block from 2011 to 2018, using the National Inpatient Sample database, with administrative claims data from more than 7 million inpatient hospitalizations annually. Patients with a preexisting pacemaker were excluded. The primary endpoint was in‐hospital mortality; secondary endpoints included in‐hospital complications, total hospital cost, length of stay and discharge disposition, defined as home discharge vs. nonhome discharge.
The findings were published in Catheterization and Cardiovascular Interventions.
From 2011 to 2018, 194,237 patients underwent TAVR in which 1.7% had a right bundle branch block and 13.7% had a left bundle branch block.
Adjusted in‐hospital mortality was not statistically different between TAVR patients with a right bundle branch block and without a bundle branch block, but trended lower in patients with right bundle branch block (1.5% vs. 2.6%; P = .24). Patients with right bundle branch block were more likely to be discharged to a rehab facility vs. those without a bundle branch block (55.9% vs. 49.9%; P < .12); however, the difference was also not statistically significant, according to researchers.
Among patients with left bundle branch block, adjusted in‐hospital mortality was lower vs. patients without a bundle branch block (0.8% vs. 2%; P < .01).
Researchers found that patients with a right bundle branch block and a left bundle branch block had a higher rate of new permanent pacemaker, with rates of 31.5% and 15.7%, respectively, compared with patients with no bundle branch block. The median time to permanent pacemaker implantation was 2 days in patients with right bundle branch block.
Compared with a left bundle branch block, a right bundle branch block was associated with a longer median length of stay (5 days vs. 3 days), as well as a higher total hospitalization cost ($53,669 vs. $47,552). Median length of stay for patients with no bundle branch block was 3 days; median total hospitalization cost was $47,171.
In trend analyses, researchers observed lower rates of permanent pacemaker implantation and reduced lengths of stay and costs across all three groups.
“These data can help in shared decision-making with our patients and also identify patients at a highest risk for requiring pacemaker post-TAVR,” Zahid told Healio. “Future research must focus on optimal procedural techniques and management strategies to minimize the need for pacemaker following TAVR and optimize long-term outcomes in those patients requiring a pacemaker.”
For more information:
Salman Zahid, MD, can be reached at salman.zahid@rochesterregional.org; Twitter: @SalmanZahidMD.
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