UK CoreValve Collaborative, Sussex Cardiac Centre, Brighton & Sussex University Hospital Trust, Eastern Road, Brighton, East Sussex, BN2 5BE, UK.
Circulation. 2011 Mar 8;123(9):951-60. doi: 10.1161/CIRCULATIONAHA.109.927152. Epub 2011 Feb 21.
Permanent pacemaker (PPM) requirement is a recognized complication of transcatheter aortic valve implantation. We assessed the UK incidence of permanent pacing within 30 days of CoreValve implantation and formulated an anatomic and electrophysiological model.
Data from 270 patients at 10 centers in the United Kingdom were examined. Twenty-five patients (8%) had preexisting PPMs; 2 patients had incomplete data. The remaining 243 were 81.3±6.7 years of age; 50.6% were male. QRS duration increased from 105±23 to 135±29 milliseconds (P<0.01). Left bundle-branch block incidence was 13% at baseline and 61% after the procedure (P<0.001). Eighty-one patients (33.3%) required a PPM within 30 days. Rates of pacing according to preexisting ECG abnormalities were as follows: right bundle-branch block, 65.2%; left bundle-branch block, 43.75%; normal QRS, 27.6%. Among patients who required PPM implantation, the median time to insertion was 4.0 days (interquartile range, 2.0 to 7.75 days). Multivariable analysis revealed that periprocedural atrioventricular block (odds ratio, 6.29; 95% confidence interval, 3.55 to 11.15), balloon predilatation (odds ratio, 2.68; 95% confidence interval, 2.00 to 3.47), use of the larger (29 mm) CoreValve prosthesis (odds ratio, 2.50; 95% confidence interval, 1.22 to 5.11), interventricular septum diameter (odds ratio, 1.18; 95% confidence interval, 1.10 to 3.06), and prolonged QRS duration (odds ratio, 3.45; 95% confidence interval, 1.61 to 7.40) were independently associated with the need for PPM.
One third of patients undergoing a CoreValve transcatheter aortic valve implantation procedure require a PPM within 30 days. Periprocedural atrioventricular block, balloon predilatation, use of the larger CoreValve prosthesis, increased interventricular septum diameter and prolonged QRS duration were associated with the need for PPM.
永久性心脏起搏器（PPM）的需求是经导管主动脉瓣植入术的公认并发症。我们评估了英国在 CoreValve 植入后 30 天内永久性起搏的发生率，并制定了一个解剖学和电生理学模型。
在英国的 10 个中心对 270 名患者的数据进行了检查。25 名患者（8%）存在先前存在的 PPM；2 名患者数据不完整。其余 243 名患者的年龄为 81.3±6.7 岁；50.6%为男性。QRS 持续时间从 105±23 增加到 135±29 毫秒（P<0.01）。基线时有 13%的左束支传导阻滞，术后有 61%（P<0.001）。81 名患者（33.3%）在 30 天内需要 PPM。根据术前心电图异常的起搏率如下：右束支传导阻滞，65.2%；左束支传导阻滞，43.75%；正常 QRS，27.6%。需要植入 PPM 的患者中，插入 PPM 的中位时间为 4.0 天（四分位间距，2.0 至 7.75 天）。多变量分析显示，围手术期房室传导阻滞（优势比，6.29；95%置信区间，3.55 至 11.15）、球囊预扩张（优势比，2.68；95%置信区间，2.00 至 3.47）、使用较大的（29mm）CoreValve 假体（优势比，2.50；95%置信区间，1.22 至 5.11）、室间隔直径（优势比，1.18；95%置信区间，1.10 至 3.06）和 QRS 持续时间延长（优势比，3.45；95%置信区间，1.61 至 7.40）与 PPM 的需求独立相关。
三分之一接受 CoreValve 经导管主动脉瓣植入术的患者在 30 天内需要 PPM。围手术期房室传导阻滞、球囊预扩张、使用较大的 CoreValve 假体、室间隔直径增加和 QRS 持续时间延长与 PPM 的需求相关。
