Author + information
- Received June 25, 2016
- Revision received August 14, 2016
- Accepted August 25, 2016
- Published online November 14, 2016.
- Yusuke Watanabe, MDa,∗ (, )
- Ken Kozuma, MD, PhDa,
- Hirofumi Hioki, MDa,
- Hideyuki Kawashima, MD, PhDa,
- Yugo Nara, MDa,
- Akihisa Kataoka, MD, PhDa,
- Fukuko Nagura, MDa,
- Makoto Nakashima, MDa,
- Shinichi Shirai, MDb,
- Norio Tada, MDc,
- Motoharu Araki, MDd,
- Kensuke Takagi, MDe,
- Futoshi Yamanaka, MDf,
- Masanori Yamamoto, MD, PhDg,h and
- Kentaro Hayashida, MD, PhDi
- aTeikyo University School of Medicine, Tokyo, Japan
- bKokura Memorial Hospital, Fukuoka, Japan
- cSendai Kousei Hospital, Miyagi, Japan
- dSaiseikai Yokohama-City Eastern Hospital, Kanagawa, Japan
- eNew Tokyo Hospital, Chiba, Japan
- fShonan Kamakura General Hospital, Kanagawa, Japan
- gToyohashi Heart Center, Aichi, Japan
- hNagoya Heart Center, Aichi, Japan
- iKeio University School of Medicine, Tokyo, Japan
- ↵∗Reprint requests and correspondence:
Dr. Yusuke Watanabe, Teikyo University School of Medicine, 2-11-1 Kaga, Tokyo 173-8606, Japan.
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.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received June 25, 2016.
- Revision received August 14, 2016.
- Accepted August 25, 2016.
- American College of Cardiology Foundation