Clinical Validation of the 2021 European Society of Cardiology Guidelines on Pre-existing Right Bundle Branch Block in Patients undergoing Transcatheter Aortic Valve Implantation.

Abstract

Risk stratification of patients with right bundle branch block (RBBB) undergoing transcatheter aortic valve implantation (TAVI) remains challenging. To evaluate the European Society of Cardiology (ESC) criteria for risk stratification of RBBB patients undergoing TAVI. We retrospectively analyzed prospectively enrolled patients with pre-existing RBBB undergoing TAVI between 2011-2023. A surface 12-lead electrocardiogram was available before and after the procedure in all patients. The following ESC criteria were validated: ΔPR interval ≥20 ms, QRS axis change or transient high-degree atrioventricular block (HAVB) <24 hours after TAVI. Pre-existing RBBB was documented in 107 out of 1,410 patients (7.6%) undergoing TAVI. Mean age was 83±5 years, 34% were female, and 66% received self-expandable valves. Of those 107 patients with pre-existing RBBB, 36 (34%) developed persistent HAVB lasting longer than 24 hours and received permanent pacemaker therapy. Among the remaining 71 patients, 16 patients (23%) developed delayed HAVB during 30-days of follow-up. The ESC criteria identified 81% of patients (13/16) with delayed HAVB during 30-day follow-up, while missing 3 patients (19%, 2.8% of the overall cohort). This resulted in a sensitivity of 81% and a negative predictive value of 92%. Meeting the ESC criteria bore a 6-fold increase in the odds of developing HAVB during 30-day follow-up (OR 6.5, 95%-CI 1.84-30.8, p = 0.007). In this large cohort of patients with pre-existing RBBB undergoing TAVI with contemporary prosthesis and implantation techniques, the ESC criteria - PR prolongation, QRS axis change or transient HAVB - correctly identified 4/5 patients developing HAVB during 30-day follow-up.