Baseline left bundle branch block or left anterior or posterior fascicular block in patients undergoing transcatheter tricuspid valve replacement (TTVR) are associated with a higher risk of high-grade atrioventricular block (HAVB) post procedure, according to a study published July 9 in JACC: Cardiovascular Interventions.

Evaluating consecutive patients captured by the TRIPLACE Registry (Global Multicenter Registry on Transcatheter Tricuspid Valve Replacement), Andrea Scotti, MD, et al., included 185 patients (mean age 76.4 ± 8.7 years, 68.7% women) without permanent pacemaker implantation undergoing TTVR. The study's primary endpoint was HAVB at one month after TTVR.

Overall, 25 patients (14%) experienced HAVB at one month, with 88% occurring within the first week post procedure (median 3.0 days; Q1-Q3, 2.0-5.0). The authors also found that 21%, of patients undergoing TTVR experienced new-onset right bundle branch block.

After adjustment for age and degree of device oversizing, baseline left bundle branch block or left anterior or posterior fascicular block was independently associated with HAVB (adjusted odds ratio, 3.63; 95% CI, 1.28-10.37; p=0.016).

Permanent pacemaker implantation was performed in those experiencing the HAVB complication with 46% using leadless technologies, 27% with coronary sinus leads and 27% with transvalvular dual-chamber pacemakers.

Given their findings, the authors suggest the use of wearable telemetry devices post TTVR to help monitor conduction disturbances. "A monitoring period extending up to one month appears reasonable for TTVR recipients, particularly for those with baseline [left bundle branch block] and [left anterior or posterior fascicular block]," state the authors. "If no wearable telemetry devices are available, inpatient monitoring in a telemetry unit is advisable for at least three days post-TTVR or longer if new postprocedural conduction disturbances develop."

In an accompanying editorial comment, Auroa Badin, MD, and Steven J. Yakubov, MD, FACC, write: "It is important to acknowledge that the registry's follow-up was relatively short (30 days), potentially missing late-onset HAVB. Furthermore, data on pacing-related complications...and the impact of [permanent pacemaker] type on valvular function remain incomplete."