Right Bundle Branch Block Pre-Transcatheter Aortic Valve Replacement: Is a Pacemaker the Answer for Everyone?
Why this work is in the frame
A frame that forgets how it found something cannot be audited. These are the routes that admitted this work.
Bibliographic record
Abstract
Since the first-in-human procedure in 2002, transcatheter aortic valve replacement (TAVR) has become a well-established therapeutic option for severe aortic stenosis, and TAVR volume recently surpassed surgical aortic valve replacement in the United States.Despite improvements in techniques, the rate of conduction disturbances requiring permanent pacemaker (PPM) implantation remains relatively high. 1 Several pre-and peri-procedural risk factors have been described. 2Pre-existing right bundle branch block (RBBB) is one of the strongest predictors of high-degreeatrioventricular block after TAVR.This risk persists for up to 7 days, with a higher latent risk with self-expanding valves.The reported rate of PPM implantation at 30 days is approximately 40% to 50%. 3 A 2020 consensus states that in this population with pre-existing RBBB, it is reasonable to maintain transvenous pacing capability with continuous cardiac monitoring irrespective of new changes in PR or QRS duration for at least 24 hours. 4he risk of conduction disturbances occurring at a distance from the TAVR procedure and the reported excess of mortality in patients with RBBB without a pacemaker have led some teams to adopt a more aggressive approach with a systematic preprocedural pacemaker implantation. 5n the other hand, PPM implantation is associated with increased risks during long-term follow-up (lead dislodgement or dysfunction, infection, etc.), and this becomes particularly relevant as we are currently expanding TAVR to a younger population.In this issue of Structural Heart, Zorman et al. describe a cohort of 170 patients with pre-existing RBBB who underwent TAVR at two large UK centers between 2014 and 2022.Of these, 62.5% underwent a prophylactic PPM implantation based on physician preference prior to hospitalization (6 to 65 days) for TAVR.They were compared to a group of patients who did not undergo prophylactic PPM.Of these, 57.8% required a PPM implantation within 30 days of TAVR.While the majority of PPMs were implanted during the
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.005 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from it