Impact of Pre-Existing Right Bundle Branch Block on In-Hospital Outcomes Following Transcatheter Aortic Valve Replacement: Insight from National Inpatient Sample Database, 2016-2019.

Right bundle branch block (RBBB) is a common finding in older adults and may have higher complications following the transcutaneous aortic valve replacement (TAVR) procedure. The National Inpatient Sample (NIS) was queried for all hospitalizations undergoing percutaneous TAVR from 2016 to 2019. Cohorts with RBBB were compared to hospitalized patients without RBBB. Weighted multivariable logistic regression was used to assess the association between RBBB and in-hospital outcomes. Out of 203,900 procedures performed, 5.05% had RBBB, and 94.95% didn't have RBBB. The primary outcome of in-hospital mortality was not statistically different between patients with and without RBBB (0.92% vs 1.41%, OR: 0.65, 95% CI: 0.41-1.03, P = 0.07), a finding that did not change when adjusted for comorbidities in multivariate analysis (adjusted OR: 0.65, 95% CI: 0.41-1.05, P = 0.08). In the RBBB group, total complication rates were higher (adjusted OR: 3.67, 95% CI: 3.32-4.06, P<0.001), driven primarily by pacemaker implantation (adjusted OR: 4.18, 95% CI: 3.77-4.63, P<0.001). We also found higher cardiac arrest (adjusted OR: 2.46, 95% CI: 1.08-23.99, P = 0.001) and post-procedural heart failure (adjusted OR: 2.75, 95% CI: 1.07-7.08, P = 0.036). Hence patient with a history of RBBB who undergo TAVR have an increased need for permanent pacemaker implantation compared to those without a right bundle branch block. Whether extended monitoring post TAVR would reduce complications is a matter of further study.