Background: Transcatheter aortic valve implantation(TAVI) is the standard treatment option for patients with severe aortic stenosis (AS) at intermediate or high surgical risk. Preexisting right bundle branch block (RBBB) is a strong predictor for new pacemaker implantation (PPM) after TAVI, and previous data indicate a worse short- and long-term outcome of patients.  

Objective: The aim of this study was to investigate whether preexisting RBBB has an effect on the short- and long-term outcome of patients undergoing TAVI in a German high-volume TAVI center.

Methods: Between 2010 and 2019 a total of 3086 patients with high-grade AS undergoing TAVI at a single center were included in a TAVI registry. For the present post-hoc analysis, a total of 2407 patients with native severe AS with successful TAVI without preexisting PPM were included. The primary endpoint was all-cause mortality after 30 days and 12 months. Baseline RBBB was present in 244 (10.1%) of cases. 

Results: Patients with preexisting RBBB had a considerably higher rate of new PPM after TAVI compared with patients without RBBB (104/244 [42.6%] vs. 265/2163 [12.3%]; p<0.001). RBBB had no impact on all-cause mortality at 30 days (4.5% vs. 4.8%; p=0.86) and at 12 months (15.6% vs. 16.6%; p=0.696). Further stratification according to the presence of new PPM showed no difference in survival rates between the groups (log-rank p=0.267).

Conclusion: Preexisting RBBB is a common finding in patients with severe AS undergoing TAVI and is associated with considerably higher PPM rates but not with worse short- and long-term outcome.