The Association Between TAVR Approach and Complete Bundle Branch Blocks

Background
A common complication after TAVR is new-onset complete bundle branch block, which has been associated with increased mortality and pacemaker implantation. The purpose of this study was to determine the association between TAVR approach (femoral vs apical) and incidence of new-onset bundle branch block.

Methods
A retrospective, observational study of consecutive patients undergoing TAVR between 2012 and 2018 at a large, single institution. Those with pacemakers or bundle branch block prior to TAVR were excluded. The incidence of new onset right or left bundle branch block, in addition to demographic information, was recorded. Univariate analysis was performed using the chi-square test of independence. Multivariate analysis using multiple logistic regression included cardiovascular disease risk factors of age, gender, presence of hypertension and diabetes.

Results
Of 490 subjects who underwent TAVR, 467 met inclusion criteria with 283 (60.6%) femoral approach and 184 (39.4%) apical approach. The apical approach was associated with a higher incidence of both new onset LBBB (12.8% vs 3.40%, p=0.0002) and RBBB (5.49% vs 0.81%, p=0.0039). After controlling for risk factors, the apical approach continued to be associated with a higher incidence of both new onset LBBB (p=0.0010) and RBBB (p=0.0115).

Conclusions
TAVR using apical approach was found to be an independent risk factor for complete bundle branch block.