Cargando…

Clinical Impact of Preexisting Right Bundle Branch Block after Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-Analysis

INTRODUCTION: Transcatheter aortic valve replacement (TAVR) is now the treatment of choice for patients with severe aortic stenosis regardless of their surgical risk. Right bundle branch block (RBBB) can be a predictor for development of significant atrioventricular (AV) block after TAVR, requiring...

Descripción completa

Detalles Bibliográficos
Autores principales: Saint Croix, Garly R., Lacy, Spencer C., Hrachian, Hakop, Beohar, Nirat
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Hindawi 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7396100/
https://www.ncbi.nlm.nih.gov/pubmed/32774182
http://dx.doi.org/10.1155/2020/1789516
_version_ 1783565521760813056
author Saint Croix, Garly R.
Lacy, Spencer C.
Hrachian, Hakop
Beohar, Nirat
author_facet Saint Croix, Garly R.
Lacy, Spencer C.
Hrachian, Hakop
Beohar, Nirat
author_sort Saint Croix, Garly R.
collection PubMed
description INTRODUCTION: Transcatheter aortic valve replacement (TAVR) is now the treatment of choice for patients with severe aortic stenosis regardless of their surgical risk. Right bundle branch block (RBBB) can be a predictor for development of significant atrioventricular (AV) block after TAVR, requiring permanent pacemaker implantation (PPI). However, data related to the risk of PPI requirement with preexisting RBBB is scarce. Hence, this systematic review and meta-analysis aims to assess clinical outcomes of patients undergoing TAVR with RBBB on preexisting electrocardiogram. METHODS: We performed a systematic literature review to identify randomized and nonrandomized clinical studies that reported any clinical impact of patients undergoing TAVR with preexisting RBBB. A total of eight databases including PubMed (Medline), Embase, Cochrane Library, ACP Journal Club, Scopus, DARE, and Ovid containing articles from January 2000 to May 2020 were analyzed. RESULTS: We identified and screened 224 potential eligible publications through the databases and found 14 relevant clinical trials for a total of 15,319 participants. There was an increased 30-day pacemaker implantation rate of 38.1% in the RBBB group compared to 11.4% in the no RBBB group with a risk ratio of 3.56 (RR 3.56 (95% CI 3.21–3.93, p < 0.01)). There was an increased 30-day all-cause mortality in the RBBB group of 9.5% compared with 6.3% in the no RBBB group with an odds ratio of 1.60 (OR 1.60 (95% CI 1.14–2.25, p < 0.01)). CONCLUSION: This study indicates that patients with preexisting RBBB have higher incidence of PPI and all-cause mortality after TAVR compared with patients without RBBB. Further trials are needed to compare the clinical outcomes based on TAVR valve types and assess the benefit of PPI in patients with new-onset RBBB after TAVR.
format Online
Article
Text
id pubmed-7396100
institution National Center for Biotechnology Information
language English
publishDate 2020
publisher Hindawi
record_format MEDLINE/PubMed
spelling pubmed-73961002020-08-07 Clinical Impact of Preexisting Right Bundle Branch Block after Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-Analysis Saint Croix, Garly R. Lacy, Spencer C. Hrachian, Hakop Beohar, Nirat J Interv Cardiol Research Article INTRODUCTION: Transcatheter aortic valve replacement (TAVR) is now the treatment of choice for patients with severe aortic stenosis regardless of their surgical risk. Right bundle branch block (RBBB) can be a predictor for development of significant atrioventricular (AV) block after TAVR, requiring permanent pacemaker implantation (PPI). However, data related to the risk of PPI requirement with preexisting RBBB is scarce. Hence, this systematic review and meta-analysis aims to assess clinical outcomes of patients undergoing TAVR with RBBB on preexisting electrocardiogram. METHODS: We performed a systematic literature review to identify randomized and nonrandomized clinical studies that reported any clinical impact of patients undergoing TAVR with preexisting RBBB. A total of eight databases including PubMed (Medline), Embase, Cochrane Library, ACP Journal Club, Scopus, DARE, and Ovid containing articles from January 2000 to May 2020 were analyzed. RESULTS: We identified and screened 224 potential eligible publications through the databases and found 14 relevant clinical trials for a total of 15,319 participants. There was an increased 30-day pacemaker implantation rate of 38.1% in the RBBB group compared to 11.4% in the no RBBB group with a risk ratio of 3.56 (RR 3.56 (95% CI 3.21–3.93, p < 0.01)). There was an increased 30-day all-cause mortality in the RBBB group of 9.5% compared with 6.3% in the no RBBB group with an odds ratio of 1.60 (OR 1.60 (95% CI 1.14–2.25, p < 0.01)). CONCLUSION: This study indicates that patients with preexisting RBBB have higher incidence of PPI and all-cause mortality after TAVR compared with patients without RBBB. Further trials are needed to compare the clinical outcomes based on TAVR valve types and assess the benefit of PPI in patients with new-onset RBBB after TAVR. Hindawi 2020-07-21 /pmc/articles/PMC7396100/ /pubmed/32774182 http://dx.doi.org/10.1155/2020/1789516 Text en Copyright © 2020 Garly R. Saint Croix et al. http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research Article
Saint Croix, Garly R.
Lacy, Spencer C.
Hrachian, Hakop
Beohar, Nirat
Clinical Impact of Preexisting Right Bundle Branch Block after Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-Analysis
title Clinical Impact of Preexisting Right Bundle Branch Block after Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-Analysis
title_full Clinical Impact of Preexisting Right Bundle Branch Block after Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-Analysis
title_fullStr Clinical Impact of Preexisting Right Bundle Branch Block after Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-Analysis
title_full_unstemmed Clinical Impact of Preexisting Right Bundle Branch Block after Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-Analysis
title_short Clinical Impact of Preexisting Right Bundle Branch Block after Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-Analysis
title_sort clinical impact of preexisting right bundle branch block after transcatheter aortic valve replacement: a systematic review and meta-analysis
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7396100/
https://www.ncbi.nlm.nih.gov/pubmed/32774182
http://dx.doi.org/10.1155/2020/1789516
work_keys_str_mv AT saintcroixgarlyr clinicalimpactofpreexistingrightbundlebranchblockaftertranscatheteraorticvalvereplacementasystematicreviewandmetaanalysis
AT lacyspencerc clinicalimpactofpreexistingrightbundlebranchblockaftertranscatheteraorticvalvereplacementasystematicreviewandmetaanalysis
AT hrachianhakop clinicalimpactofpreexistingrightbundlebranchblockaftertranscatheteraorticvalvereplacementasystematicreviewandmetaanalysis
AT beoharnirat clinicalimpactofpreexistingrightbundlebranchblockaftertranscatheteraorticvalvereplacementasystematicreviewandmetaanalysis