Calvi Valeria, Puzzangara Euglena, Pruiti Giusi Paola, Conti Sergio, Di Grazia Angelo, Ussia Gian Paolo, Capodanno Davide, Tamburino Corrado
Cardiology Department, Ferrarotto Hospital, University of Catania, Catania, Italy.
Pacing Clin Electrophysiol. 2009 Mar;32 Suppl 1:S126-30. doi: 10.1111/j.1540-8159.2008.02298.x.
Percutaneous aortic valve replacement (PAVR) may be an alternative therapy for patients with severe aortic stenosis who are denied valve surgery because of age and comorbidity. Data are few regarding the incidence of early conduction disorders (CD) after PAVR. We examined the incidence and characteristics of CD in the immediate postoperative period after PAVR, and the need for permanent pacemaker (PPM) implantation.
Between June 2007 and June 2008 30 patients (mean age = 82.1 +/- 8.5 years) underwent PAVR in our institution. The incidence of new, postoperative CD, diagnosed by 12-lead or 24-hour Holter electrocardiogram, was 68.0%. Left bundle branch block was the most common conduction abnormality, with an incidence of 45.8%. The incidence of complete atrioventricular block requiring PPM implantation was 20%.
We observed a higher incidence of early conduction disorders and need for PPM implantation after PAVR than generally reported after surgery. Whether this observation is clinically important requires larger prospective studies and follow up.
经皮主动脉瓣置换术（PAVR）可能是因年龄和合并症而被拒绝接受瓣膜手术的重度主动脉瓣狭窄患者的一种替代治疗方法。关于PAVR术后早期传导障碍（CD）发生率的数据较少。我们研究了PAVR术后即刻CD的发生率和特征，以及永久起搏器（PPM）植入的必要性。
2007年6月至2008年6月期间，我们机构有30例患者（平均年龄=82.1±8.5岁）接受了PAVR。通过12导联或24小时动态心电图诊断的术后新发CD发生率为68.0%。左束支传导阻滞是最常见的传导异常，发生率为45.8%。需要植入PPM的完全性房室传导阻滞发生率为20%。
我们观察到PAVR术后早期传导障碍的发生率和PPM植入的必要性高于一般手术报告。这一观察结果是否具有临床重要性需要更大规模的前瞻性研究和随访。
