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. 2021 Jun 19;10(12):2719.
doi: 10.3390/jcm10122719.

Impact of Bundle Branch Block on Permanent Pacemaker Implantation after Transcatheter Aortic Valve Implantation: A Meta-Analysis

Justine M Ravaux  1 , Michele Di Mauro  1 , Kevin Vernooy  2   3   4 , Silvia Mariani  1 , Daniele Ronco  1   5 , Jorik Simons  1 , Arnoud W Van't Hof  2   3 , Leo Veenstra  2 , Suzanne Kats  1 , Jos G Maessen  1   3 , Roberto Lorusso  1   3
Affiliations

Impact of Bundle Branch Block on Permanent Pacemaker Implantation after Transcatheter Aortic Valve Implantation: A Meta-Analysis

Justine M Ravaux et al. J Clin Med. .

Abstract

Data regarding the impact of infra-Hisian conduction disturbances leading to permanent pacemaker implantation (PPI) after transcatheter aortic valve implantation (TAVI) remain limited. The aim of this study was to determine the impact of right and/or left bundle branch block (RBBB/LBBB) on post-TAVI PPI. We performed a systematic literature review to identify studies reporting on RBBB and/or LBBB status and post-TAVI PPI. Study design, patient characteristics, and the presence of branch block were analyzed. Odds ratios (ORs) with 95% CI were extracted. The final analysis included 36 studies, reporting about 55,851 patients. Data on LBBB were extracted from 33 studies. Among 51,026 patients included, 5503 showed pre-implant LBBB (11.9% (10.4%-13.8%)). The influence of LBBB on post-TAVI PPI was not significant OR 1.1474 (0.9025; 1.4588), p = 0.2618. Data on RBBB were extracted from 28 studies. Among 46,663 patients included, 31,603 showed pre-implant RBBB (9.2% (7.3%-11.6%)). The influence of RBBB on post-TAVI PPI was significant OR 4.8581 (4.1571; 5.6775), p < 0.0001. From this meta-analysis, the presence of RBBB increased the risk for post-TAVI PPI, independent of age or LVEF, while this finding was not confirmed for patients experimenting with LBBB. This result emphasizes the need for pre-operative evaluation strategies in patient selection for TAVI.

Keywords: left bundle branch block; permanent pacemaker implantation; right bundle branch block; transcatheter aortic valve implantation.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Forest plot comparing the effect of LBBB on the rate of post-TAVI PPI. IV= interval variable; 95% CI = confidence interval.
Figure 2
Figure 2
Forest plot leave one-out analysis comparing the effect of the presence of LBBB on the rate of post-TAVI PPI. IV= interval variable; 95% CI= confidence interval.
Figure 3
Figure 3
Forest plot comparing the effect of RBBB on the rate of post-TAVI PPI.
Figure 4
Figure 4
Forest plot leave one-out analysis comparing the effect of the presence of RBBB on the rate of post-TAVI PPI.
See this image and copyright information in PMC

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