Abstract 13408: Have We Improved? Right Bundle Branch Block and Transcatheter Aortic Valve Replacement: An Analysis of the National Inpatient Database

Abstract

Background: Pre-existing right bundle branch block (pRBBB) is recognized as a significant risk factor for the need of permanent pacemaker (PPM) therapy after TAVR, with early studies suggesting additional risk of mortality and hospitalization. This study aims to explore contemporary in-hospital outcomes of TAVR patients with pRBBB. Methods: Using the National Inpatient Database (NIS) we identified patients 18 years and older hospitalized for index TAVR procedure from 2016 to 2018. Primary outcome was incidence of PPM implant post-TAVR. Secondary outcomes included in-hospital mortality and length of stay (LOS). Multivariate analysis model was used to adjust for statistically significant differences in baseline characteristics between the groups. Results: A total of 152,490 patients underwent TAVR. Pre-existing RBBB was present in 7090 (4.6%) patients. Patients with pRBBB were less likely to be women (34.6% vs 46.8%, p < 0.001) and more likely to suffer from heart failure (76.9% vs 74.3%, p < 0.001) and diabetes (40.2% vs 37.3%, p < 0.001). Those with pRBBB were more likely to undergo PPM implant (29.4% vs 9.1%, OR 3.776, p < 0.001). There was no significant difference in in-hospital mortality (1.3% vs 1.5%, p = 0.203) or LOS (4.51 ± 5.15 vs 4.38 ± 5.54 days, p= 0.062) between the groups. Subgroup analysis showed that the incidence of PPM implant (29.1% vs 14.6%, p < 0.001), in-hospital mortality (1.4% vs 0.7%, p < 0.001), cardiogenic shock (2.1% vs 1.5%, p < 0.001) and mechanical ventilation (3.1% vs 2.0%, p < 0.001) was higher among patients with pRBBB compared to those with pre-existing LBBB (pLBBB). Conclusions: Contrary to previous reports, patients with pRBBB did not show increased risk of in-hospital mortality or LOS compared to those without RBBB. pRBBB was, as expected, associated with increased risk for PPM implant post-TAVR. When compared to patients with pLBBB, those with pRBBB appear to experience worse in-hospital outcomes, suggesting an area for further research.