Clinical validation of the 2021 European Society of Cardiology guidelines on preexisting right bundle branch block in patients undergoing transcatheter aortic valve implantation

Salis, M; Badertscher, P; Papa, A; Knecht, S; Serban, T; Nestelberger, T; Kaiser, C; Leibundgut, G; Schaer, B; Krisai, P; Mahfoud, F; Kühne, M; Sticherling, C

doi:10.1016/j.hrthm.2024.11.030

Valvular & structural heart disease

Clinical validation of the 2021 European Society of Cardiology guidelines on preexisting right bundle branch block in patients undergoing transcatheter aortic valve implantation

Heart RhythmPublished 22 Nov 2024Diagnostic accuracy study

Performance · Delayed HAVB during 30-day follow-up identified by ESC criteriaResultOdds ratio 6.5 95% CI 1.84–30.8

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Authors' conclusion

In this large cohort of patients with preexisting RBBB undergoing TAVI with contemporary prosthesis and implantation techniques, the ESC criteria-PR prolongation, QRS axis change, and transient HAVB-correctly identified 4 of 5 patients in whom HAVB developed during 30-day follow-up.

Study context

Population: Patients with preexisting right bundle branch block (RBBB) undergoing transcatheter aortic valve implantation (TAVI), 2011–2023of 1410 TAVI patients
Participants: 107 patients

Comparison: European Society of Cardiology (ESC) criteria for risk stratification of preexisting RBBB after TAVI
Outcome: Delayed HAVB
Follow-up: 30-day follow-up

Methodological detailsretrospective analysis of prospectively enrolled patients

Retrospective analysis of prospectively enrolled patients

Performance

As reported in the abstract

Delayed HAVB during 30-day follow-up identified by ESC criteria · 30 days

Odds ratio

6.5

95% CI 1.84–30.8

P = 0.007

Events by group

ESC criteria

81%

13 events

Meeting the ESC criteria

OR 6.5 (95% CI 1.84–30.8); P = 0.007

Further findings

Persistent HAVB >24 h with permanent pacemaker (all RBBB patients)

Persistent HAVB lasting >24 h, permanent pacemaker: 36 (34%)

Of 107 patients with preexisting RBBB

Delayed HAVB during 30-day follow-up (remaining 71 patients)

Delayed HAVB: 16 patients (23%)

Of the remaining 71 patients

Original publication

Clinical validation of the 2021 European Society of Cardiology guidelines on preexisting right bundle branch block in patients undergoing transcatheter aortic valve implantation. Heart Rhythm. Published 22 November 2024. doi:10.1016/j.hrthm.2024.11.030

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Summarised from the published abstract; every number is checked against it