Pre-Existing Right Bundle Branch Block Increases Risk for Death After Transcatheter Aortic Valve Replacement With a Balloon-Expandable Valve
Abstract Objectives The aim of this study was to determine the impact of pre-existing right bundle branch block (RBBB) on clinical outcomes after transcatheter aortic valve replacement (TAVR). Background The impact of pre-existing RBBB on clinical outcomes after TAVR is unknown. Methods Between Octo...
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| Veröffentlicht in: | JACC. Cardiovascular interventions 2016-11, Vol.9 (21), p.2210-2216 |
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| creator | Watanabe, Yusuke, MD Kozuma, Ken, MD, PhD Hioki, Hirofumi, MD Kawashima, Hideyuki, MD, PhD Nara, Yugo, MD Kataoka, Akihisa, MD, PhD Nagura, Fukuko, MD Nakashima, Makoto, MD Shirai, Shinichi, MD Tada, Norio, MD Araki, Motoharu, MD Takagi, Kensuke, MD Yamanaka, Futoshi, MD Yamamoto, Masanori, MD, PhD Hayashida, Kentaro, MD, PhD |
| description | Abstract Objectives The aim of this study was to determine the impact of pre-existing right bundle branch block (RBBB) on clinical outcomes after transcatheter aortic valve replacement (TAVR). Background The impact of pre-existing RBBB on clinical outcomes after TAVR is unknown. Methods Between October 2013 and August 2015, 749 patients undergoing TAVR using the Edwards SAPIEN XT prosthesis were prospectively enrolled in the OCEAN-TAVI (Optimized Transcatheter Valvular Intervention) registry from 8 Japanese centers. Electrocardiograms were obtained at baseline. After the procedure, follow-up outpatient visits or telephone interviews were conducted at 30 days, 6 months, and yearly. Results A total of 102 patients (13.6%) had pre-existing RBBB. The incidence of new pacemaker implantation was significantly higher in the RBBB group (17.6% vs. 2.9%; p < 0.01). The Kaplan-Meier analysis revealed that cardiovascular survival probability was significantly lower in the RBBB group than the no-RBBB group (log-rank p < 0.01). Patients with RBBB and without pacemakers were at higher risk for cardiovascular mortality in the early phase after discharge, and patients with RBBB and pacemakers had higher cardiovascular mortality at mid-term follow-up (log-rank p = 0.01). A multivariate Cox regression model indicated that pre-existing RBBB (hazard ratio: 2.59; 95% confidence interval: 1.15 to 5.85; p < 0.01) was an independent predictor of cardiovascular mortality. Conclusions Patients with RBBB demonstrated an increased risk for cardiovascular mortality after TAVR, and patients with RBBB and without pacemakers were at higher risk for cardiac death early after discharge. Patients with prior RBBB should be carefully monitored after undergoing TAVR. |
| doi_str_mv | 10.1016/j.jcin.2016.08.035 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1839114560</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>1_s2_0_S1936879816314248</els_id><sourcerecordid>1839114560</sourcerecordid><originalsourceid>FETCH-LOGICAL-c411t-d4a38f0ef4b69173237ffbc19e25abe927e6affa2391a56534d501876b4471313</originalsourceid><addsrcrecordid>eNp9ks9u1DAQxiMEoqXwAhyQj1wS_CdxHAkh7ZYClSqBSoGj5TjjrrNee7GTij4E78Cz8GQ4bOHAgZNnpN83I3_fFMVTgiuCCX8xVqO2vqK5rrCoMGvuFcdEtLxsOW7u57pjvBRtJ46KRymNGHPctfRhcURbwaio-XHx_UOE8uybTZP11-jSXm8mtJ794ACto_J6g9Yu6O3PH-deR1AJUobSFpkQ0WtQ0watzAQRXWU46dzD0q1CnKxGn5W7AXQJe6c07MBP6IvNCoXWyrkQfF68V35Qfd72m31cPDDKJXhy954Un96cXZ2-Ky_evz0_XV2UuiZkKodaMWEwmLrnHWkZZa0xvSYd0Eb10NEWuDJGUdYR1fCG1UODF2P6um4JI-ykeH6Yu4_h6wxpkjubNDinPIQ5SSKyktQNxxmlB1THkFIEI_fR7lS8lQTLJQY5yiUGucQgsZA5hix6djd_7ncw_JX88T0DLw8A5F_eWIgyaQtew2Aj6EkOwf5__qt_5NpZb7VyW7iFNIY5-uyfJDJRieXH5RCWOyCckZrWgv0CrdSvag</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1839114560</pqid></control><display><type>article</type><title>Pre-Existing Right Bundle Branch Block Increases Risk for Death After Transcatheter Aortic Valve Replacement With a Balloon-Expandable Valve</title><source>MEDLINE</source><source>Elsevier ScienceDirect Journals</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><creator>Watanabe, Yusuke, MD ; Kozuma, Ken, MD, PhD ; Hioki, Hirofumi, MD ; Kawashima, Hideyuki, MD, PhD ; Nara, Yugo, MD ; Kataoka, Akihisa, MD, PhD ; Nagura, Fukuko, MD ; Nakashima, Makoto, MD ; Shirai, Shinichi, MD ; Tada, Norio, MD ; Araki, Motoharu, MD ; Takagi, Kensuke, MD ; Yamanaka, Futoshi, MD ; Yamamoto, Masanori, MD, PhD ; Hayashida, Kentaro, MD, PhD</creator><creatorcontrib>Watanabe, Yusuke, MD ; Kozuma, Ken, MD, PhD ; Hioki, Hirofumi, MD ; Kawashima, Hideyuki, MD, PhD ; Nara, Yugo, MD ; Kataoka, Akihisa, MD, PhD ; Nagura, Fukuko, MD ; Nakashima, Makoto, MD ; Shirai, Shinichi, MD ; Tada, Norio, MD ; Araki, Motoharu, MD ; Takagi, Kensuke, MD ; Yamanaka, Futoshi, MD ; Yamamoto, Masanori, MD, PhD ; Hayashida, Kentaro, MD, PhD</creatorcontrib><description>Abstract Objectives The aim of this study was to determine the impact of pre-existing right bundle branch block (RBBB) on clinical outcomes after transcatheter aortic valve replacement (TAVR). Background The impact of pre-existing RBBB on clinical outcomes after TAVR is unknown. Methods Between October 2013 and August 2015, 749 patients undergoing TAVR using the Edwards SAPIEN XT prosthesis were prospectively enrolled in the OCEAN-TAVI (Optimized Transcatheter Valvular Intervention) registry from 8 Japanese centers. Electrocardiograms were obtained at baseline. After the procedure, follow-up outpatient visits or telephone interviews were conducted at 30 days, 6 months, and yearly. Results A total of 102 patients (13.6%) had pre-existing RBBB. The incidence of new pacemaker implantation was significantly higher in the RBBB group (17.6% vs. 2.9%; p < 0.01). The Kaplan-Meier analysis revealed that cardiovascular survival probability was significantly lower in the RBBB group than the no-RBBB group (log-rank p < 0.01). Patients with RBBB and without pacemakers were at higher risk for cardiovascular mortality in the early phase after discharge, and patients with RBBB and pacemakers had higher cardiovascular mortality at mid-term follow-up (log-rank p = 0.01). A multivariate Cox regression model indicated that pre-existing RBBB (hazard ratio: 2.59; 95% confidence interval: 1.15 to 5.85; p < 0.01) was an independent predictor of cardiovascular mortality. Conclusions Patients with RBBB demonstrated an increased risk for cardiovascular mortality after TAVR, and patients with RBBB and without pacemakers were at higher risk for cardiac death early after discharge. Patients with prior RBBB should be carefully monitored after undergoing TAVR.</description><identifier>ISSN: 1936-8798</identifier><identifier>EISSN: 1876-7605</identifier><identifier>DOI: 10.1016/j.jcin.2016.08.035</identifier><identifier>PMID: 27832846</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Aged, 80 and over ; Aortic Valve - physiopathology ; Aortic Valve - surgery ; Aortic Valve Stenosis - complications ; Aortic Valve Stenosis - mortality ; Aortic Valve Stenosis - physiopathology ; Aortic Valve Stenosis - surgery ; Balloon Valvuloplasty - adverse effects ; Balloon Valvuloplasty - mortality ; Bundle-Branch Block - complications ; Bundle-Branch Block - mortality ; Bundle-Branch Block - physiopathology ; Bundle-Branch Block - therapy ; cardiac death ; Cardiac Pacing, Artificial - adverse effects ; Cardiovascular ; Chi-Square Distribution ; Female ; Heart Valve Prosthesis ; Humans ; Japan ; Kaplan-Meier Estimate ; Logistic Models ; Male ; Multivariate Analysis ; Pacemaker, Artificial ; Proportional Hazards Models ; Prospective Studies ; Prosthesis Design ; RBBB ; Registries ; Risk Assessment ; Risk Factors ; Time Factors ; transcatheter aortic valve replacement ; Transcatheter Aortic Valve Replacement - adverse effects ; Transcatheter Aortic Valve Replacement - instrumentation ; Transcatheter Aortic Valve Replacement - mortality ; Treatment Outcome</subject><ispartof>JACC. Cardiovascular interventions, 2016-11, Vol.9 (21), p.2210-2216</ispartof><rights>American College of Cardiology Foundation</rights><rights>2016 American College of Cardiology Foundation</rights><rights>Copyright © 2016 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c411t-d4a38f0ef4b69173237ffbc19e25abe927e6affa2391a56534d501876b4471313</citedby><cites>FETCH-LOGICAL-c411t-d4a38f0ef4b69173237ffbc19e25abe927e6affa2391a56534d501876b4471313</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.jcin.2016.08.035$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>314,777,781,3537,27905,27906,45976</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27832846$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Watanabe, Yusuke, MD</creatorcontrib><creatorcontrib>Kozuma, Ken, MD, PhD</creatorcontrib><creatorcontrib>Hioki, Hirofumi, MD</creatorcontrib><creatorcontrib>Kawashima, Hideyuki, MD, PhD</creatorcontrib><creatorcontrib>Nara, Yugo, MD</creatorcontrib><creatorcontrib>Kataoka, Akihisa, MD, PhD</creatorcontrib><creatorcontrib>Nagura, Fukuko, MD</creatorcontrib><creatorcontrib>Nakashima, Makoto, MD</creatorcontrib><creatorcontrib>Shirai, Shinichi, MD</creatorcontrib><creatorcontrib>Tada, Norio, MD</creatorcontrib><creatorcontrib>Araki, Motoharu, MD</creatorcontrib><creatorcontrib>Takagi, Kensuke, MD</creatorcontrib><creatorcontrib>Yamanaka, Futoshi, MD</creatorcontrib><creatorcontrib>Yamamoto, Masanori, MD, PhD</creatorcontrib><creatorcontrib>Hayashida, Kentaro, MD, PhD</creatorcontrib><title>Pre-Existing Right Bundle Branch Block Increases Risk for Death After Transcatheter Aortic Valve Replacement With a Balloon-Expandable Valve</title><title>JACC. Cardiovascular interventions</title><addtitle>JACC Cardiovasc Interv</addtitle><description>Abstract Objectives The aim of this study was to determine the impact of pre-existing right bundle branch block (RBBB) on clinical outcomes after transcatheter aortic valve replacement (TAVR). Background The impact of pre-existing RBBB on clinical outcomes after TAVR is unknown. Methods Between October 2013 and August 2015, 749 patients undergoing TAVR using the Edwards SAPIEN XT prosthesis were prospectively enrolled in the OCEAN-TAVI (Optimized Transcatheter Valvular Intervention) registry from 8 Japanese centers. Electrocardiograms were obtained at baseline. After the procedure, follow-up outpatient visits or telephone interviews were conducted at 30 days, 6 months, and yearly. Results A total of 102 patients (13.6%) had pre-existing RBBB. The incidence of new pacemaker implantation was significantly higher in the RBBB group (17.6% vs. 2.9%; p < 0.01). The Kaplan-Meier analysis revealed that cardiovascular survival probability was significantly lower in the RBBB group than the no-RBBB group (log-rank p < 0.01). Patients with RBBB and without pacemakers were at higher risk for cardiovascular mortality in the early phase after discharge, and patients with RBBB and pacemakers had higher cardiovascular mortality at mid-term follow-up (log-rank p = 0.01). A multivariate Cox regression model indicated that pre-existing RBBB (hazard ratio: 2.59; 95% confidence interval: 1.15 to 5.85; p < 0.01) was an independent predictor of cardiovascular mortality. Conclusions Patients with RBBB demonstrated an increased risk for cardiovascular mortality after TAVR, and patients with RBBB and without pacemakers were at higher risk for cardiac death early after discharge. Patients with prior RBBB should be carefully monitored after undergoing TAVR.</description><subject>Aged, 80 and over</subject><subject>Aortic Valve - physiopathology</subject><subject>Aortic Valve - surgery</subject><subject>Aortic Valve Stenosis - complications</subject><subject>Aortic Valve Stenosis - mortality</subject><subject>Aortic Valve Stenosis - physiopathology</subject><subject>Aortic Valve Stenosis - surgery</subject><subject>Balloon Valvuloplasty - adverse effects</subject><subject>Balloon Valvuloplasty - mortality</subject><subject>Bundle-Branch Block - complications</subject><subject>Bundle-Branch Block - mortality</subject><subject>Bundle-Branch Block - physiopathology</subject><subject>Bundle-Branch Block - therapy</subject><subject>cardiac death</subject><subject>Cardiac Pacing, Artificial - adverse effects</subject><subject>Cardiovascular</subject><subject>Chi-Square Distribution</subject><subject>Female</subject><subject>Heart Valve Prosthesis</subject><subject>Humans</subject><subject>Japan</subject><subject>Kaplan-Meier Estimate</subject><subject>Logistic Models</subject><subject>Male</subject><subject>Multivariate Analysis</subject><subject>Pacemaker, Artificial</subject><subject>Proportional Hazards Models</subject><subject>Prospective Studies</subject><subject>Prosthesis Design</subject><subject>RBBB</subject><subject>Registries</subject><subject>Risk Assessment</subject><subject>Risk Factors</subject><subject>Time Factors</subject><subject>transcatheter aortic valve replacement</subject><subject>Transcatheter Aortic Valve Replacement - adverse effects</subject><subject>Transcatheter Aortic Valve Replacement - instrumentation</subject><subject>Transcatheter Aortic Valve Replacement - mortality</subject><subject>Treatment Outcome</subject><issn>1936-8798</issn><issn>1876-7605</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9ks9u1DAQxiMEoqXwAhyQj1wS_CdxHAkh7ZYClSqBSoGj5TjjrrNee7GTij4E78Cz8GQ4bOHAgZNnpN83I3_fFMVTgiuCCX8xVqO2vqK5rrCoMGvuFcdEtLxsOW7u57pjvBRtJ46KRymNGHPctfRhcURbwaio-XHx_UOE8uybTZP11-jSXm8mtJ794ACto_J6g9Yu6O3PH-deR1AJUobSFpkQ0WtQ0watzAQRXWU46dzD0q1CnKxGn5W7AXQJe6c07MBP6IvNCoXWyrkQfF68V35Qfd72m31cPDDKJXhy954Un96cXZ2-Ky_evz0_XV2UuiZkKodaMWEwmLrnHWkZZa0xvSYd0Eb10NEWuDJGUdYR1fCG1UODF2P6um4JI-ykeH6Yu4_h6wxpkjubNDinPIQ5SSKyktQNxxmlB1THkFIEI_fR7lS8lQTLJQY5yiUGucQgsZA5hix6djd_7ncw_JX88T0DLw8A5F_eWIgyaQtew2Aj6EkOwf5__qt_5NpZb7VyW7iFNIY5-uyfJDJRieXH5RCWOyCckZrWgv0CrdSvag</recordid><startdate>20161114</startdate><enddate>20161114</enddate><creator>Watanabe, Yusuke, MD</creator><creator>Kozuma, Ken, MD, PhD</creator><creator>Hioki, Hirofumi, MD</creator><creator>Kawashima, Hideyuki, MD, PhD</creator><creator>Nara, Yugo, MD</creator><creator>Kataoka, Akihisa, MD, PhD</creator><creator>Nagura, Fukuko, MD</creator><creator>Nakashima, Makoto, MD</creator><creator>Shirai, Shinichi, MD</creator><creator>Tada, Norio, MD</creator><creator>Araki, Motoharu, MD</creator><creator>Takagi, Kensuke, MD</creator><creator>Yamanaka, Futoshi, MD</creator><creator>Yamamoto, Masanori, MD, PhD</creator><creator>Hayashida, Kentaro, MD, PhD</creator><general>Elsevier Inc</general><scope>6I.</scope><scope>AAFTH</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20161114</creationdate><title>Pre-Existing Right Bundle Branch Block Increases Risk for Death After Transcatheter Aortic Valve Replacement With a Balloon-Expandable Valve</title><author>Watanabe, Yusuke, MD ; Kozuma, Ken, MD, PhD ; Hioki, Hirofumi, MD ; Kawashima, Hideyuki, MD, PhD ; Nara, Yugo, MD ; Kataoka, Akihisa, MD, PhD ; Nagura, Fukuko, MD ; Nakashima, Makoto, MD ; Shirai, Shinichi, MD ; Tada, Norio, MD ; Araki, Motoharu, MD ; Takagi, Kensuke, MD ; Yamanaka, Futoshi, MD ; Yamamoto, Masanori, MD, PhD ; Hayashida, Kentaro, MD, PhD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c411t-d4a38f0ef4b69173237ffbc19e25abe927e6affa2391a56534d501876b4471313</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Aged, 80 and over</topic><topic>Aortic Valve - physiopathology</topic><topic>Aortic Valve - surgery</topic><topic>Aortic Valve Stenosis - complications</topic><topic>Aortic Valve Stenosis - mortality</topic><topic>Aortic Valve Stenosis - physiopathology</topic><topic>Aortic Valve Stenosis - surgery</topic><topic>Balloon Valvuloplasty - adverse effects</topic><topic>Balloon Valvuloplasty - mortality</topic><topic>Bundle-Branch Block - complications</topic><topic>Bundle-Branch Block - mortality</topic><topic>Bundle-Branch Block - physiopathology</topic><topic>Bundle-Branch Block - therapy</topic><topic>cardiac death</topic><topic>Cardiac Pacing, Artificial - adverse effects</topic><topic>Cardiovascular</topic><topic>Chi-Square Distribution</topic><topic>Female</topic><topic>Heart Valve Prosthesis</topic><topic>Humans</topic><topic>Japan</topic><topic>Kaplan-Meier Estimate</topic><topic>Logistic Models</topic><topic>Male</topic><topic>Multivariate Analysis</topic><topic>Pacemaker, Artificial</topic><topic>Proportional Hazards Models</topic><topic>Prospective Studies</topic><topic>Prosthesis Design</topic><topic>RBBB</topic><topic>Registries</topic><topic>Risk Assessment</topic><topic>Risk Factors</topic><topic>Time Factors</topic><topic>transcatheter aortic valve replacement</topic><topic>Transcatheter Aortic Valve Replacement - adverse effects</topic><topic>Transcatheter Aortic Valve Replacement - instrumentation</topic><topic>Transcatheter Aortic Valve Replacement - mortality</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Watanabe, Yusuke, MD</creatorcontrib><creatorcontrib>Kozuma, Ken, MD, PhD</creatorcontrib><creatorcontrib>Hioki, Hirofumi, MD</creatorcontrib><creatorcontrib>Kawashima, Hideyuki, MD, PhD</creatorcontrib><creatorcontrib>Nara, Yugo, MD</creatorcontrib><creatorcontrib>Kataoka, Akihisa, MD, PhD</creatorcontrib><creatorcontrib>Nagura, Fukuko, MD</creatorcontrib><creatorcontrib>Nakashima, Makoto, MD</creatorcontrib><creatorcontrib>Shirai, Shinichi, MD</creatorcontrib><creatorcontrib>Tada, Norio, MD</creatorcontrib><creatorcontrib>Araki, Motoharu, MD</creatorcontrib><creatorcontrib>Takagi, Kensuke, MD</creatorcontrib><creatorcontrib>Yamanaka, Futoshi, MD</creatorcontrib><creatorcontrib>Yamamoto, Masanori, MD, PhD</creatorcontrib><creatorcontrib>Hayashida, Kentaro, MD, PhD</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>JACC. Cardiovascular interventions</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Watanabe, Yusuke, MD</au><au>Kozuma, Ken, MD, PhD</au><au>Hioki, Hirofumi, MD</au><au>Kawashima, Hideyuki, MD, PhD</au><au>Nara, Yugo, MD</au><au>Kataoka, Akihisa, MD, PhD</au><au>Nagura, Fukuko, MD</au><au>Nakashima, Makoto, MD</au><au>Shirai, Shinichi, MD</au><au>Tada, Norio, MD</au><au>Araki, Motoharu, MD</au><au>Takagi, Kensuke, MD</au><au>Yamanaka, Futoshi, MD</au><au>Yamamoto, Masanori, MD, PhD</au><au>Hayashida, Kentaro, MD, PhD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Pre-Existing Right Bundle Branch Block Increases Risk for Death After Transcatheter Aortic Valve Replacement With a Balloon-Expandable Valve</atitle><jtitle>JACC. Cardiovascular interventions</jtitle><addtitle>JACC Cardiovasc Interv</addtitle><date>2016-11-14</date><risdate>2016</risdate><volume>9</volume><issue>21</issue><spage>2210</spage><epage>2216</epage><pages>2210-2216</pages><issn>1936-8798</issn><eissn>1876-7605</eissn><abstract>Abstract Objectives The aim of this study was to determine the impact of pre-existing right bundle branch block (RBBB) on clinical outcomes after transcatheter aortic valve replacement (TAVR). Background The impact of pre-existing RBBB on clinical outcomes after TAVR is unknown. Methods Between October 2013 and August 2015, 749 patients undergoing TAVR using the Edwards SAPIEN XT prosthesis were prospectively enrolled in the OCEAN-TAVI (Optimized Transcatheter Valvular Intervention) registry from 8 Japanese centers. Electrocardiograms were obtained at baseline. After the procedure, follow-up outpatient visits or telephone interviews were conducted at 30 days, 6 months, and yearly. Results A total of 102 patients (13.6%) had pre-existing RBBB. The incidence of new pacemaker implantation was significantly higher in the RBBB group (17.6% vs. 2.9%; p < 0.01). The Kaplan-Meier analysis revealed that cardiovascular survival probability was significantly lower in the RBBB group than the no-RBBB group (log-rank p < 0.01). Patients with RBBB and without pacemakers were at higher risk for cardiovascular mortality in the early phase after discharge, and patients with RBBB and pacemakers had higher cardiovascular mortality at mid-term follow-up (log-rank p = 0.01). A multivariate Cox regression model indicated that pre-existing RBBB (hazard ratio: 2.59; 95% confidence interval: 1.15 to 5.85; p < 0.01) was an independent predictor of cardiovascular mortality. Conclusions Patients with RBBB demonstrated an increased risk for cardiovascular mortality after TAVR, and patients with RBBB and without pacemakers were at higher risk for cardiac death early after discharge. Patients with prior RBBB should be carefully monitored after undergoing TAVR.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>27832846</pmid><doi>10.1016/j.jcin.2016.08.035</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Aged, 80 and over Aortic Valve - physiopathology Aortic Valve - surgery Aortic Valve Stenosis - complications Aortic Valve Stenosis - mortality Aortic Valve Stenosis - physiopathology Aortic Valve Stenosis - surgery Balloon Valvuloplasty - adverse effects Balloon Valvuloplasty - mortality Bundle-Branch Block - complications Bundle-Branch Block - mortality Bundle-Branch Block - physiopathology Bundle-Branch Block - therapy cardiac death Cardiac Pacing, Artificial - adverse effects Cardiovascular Chi-Square Distribution Female Heart Valve Prosthesis Humans Japan Kaplan-Meier Estimate Logistic Models Male Multivariate Analysis Pacemaker, Artificial Proportional Hazards Models Prospective Studies Prosthesis Design RBBB Registries Risk Assessment Risk Factors Time Factors transcatheter aortic valve replacement Transcatheter Aortic Valve Replacement - adverse effects Transcatheter Aortic Valve Replacement - instrumentation Transcatheter Aortic Valve Replacement - mortality Treatment Outcome |
| title | Pre-Existing Right Bundle Branch Block Increases Risk for Death After Transcatheter Aortic Valve Replacement With a Balloon-Expandable Valve |
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