Koos Ralf, Mahnken Andreas Horst, Aktug Omer, Dohmen Guido, Autschbach Rüdiger, Marx Nikolaus, Hoffmann Rainer
Department of Cardiology, University Hospital RWTH Aachen, RWTH University Aachen, Aachen, Germany.
J Heart Valve Dis. 2011 Jan;20(1):83-90.
Pacemaker (PM) implantation is a possible requirement after transcatheter aortic valve implantation (TAVI). The study aim was to evaluate the electrocardiographic and imaging predictors of the need for PM implantation after TAVI.
A total of 80 consecutive patients (mean age 82 +/- 6 years) who had been referred for TAVI were included in the study. Transfemoral TAVI was performed in 58 patients (CoreValve ReValving; 72%), while 22 patients (28%) underwent transapical TAVI using the Edwards SAPIEN valve. Patient characteristics, and the frequency of atrioventricular (AV) block, right bundle branch block (RBBB) and left bundle branch block (LBBB), were evaluated for the prediction of PM implantation after TAVI. In addition, the severity and distribution of aortic valve calcification (AVC) were assessed by calculating the Agatston AVC score for the total aortic valve, as well as for each cusp, using dual-source computed tomography.
Pre-procedural RBBB was present in six patients (8%), while eight patients (10%) showed pre-procedural LBBB. In 20 of the 80 patients (25%), a new LBBB was observed after TAVI. In 17 TAVI patients (21%; only CoreValve patients) there was an indication for permanent PM implantation that was related to complete AV block (n = 13) or complete RBBB or LBBB with AV delay (n = 4). Four of six patients (67%) with pre-procedural RBBB received a PM after TAVI. Multivariate logistic regression analysis revealed that only prosthesis type (r = 0.30, p = 0.01) and pre-procedural RBBB (r = 0.4, p = 0.02) were significantly associated with the need for permanent PM implantation after TAVI.
TAVI is frequently associated with new conduction disturbances. A higher incidence of new LBBB and of permanent PM requirement occurred with the CoreValve ReValving system. There was no relationship between the severity or distribution of AVC and the need for PM implantation after TAVI. Patients with pre-procedural RBBB are deemed to be at risk for PM implantation after TAVI.
经导管主动脉瓣植入术（TAVI）后可能需要植入起搏器（PM）。本研究旨在评估TAVI后PM植入需求的心电图及影像学预测因素。
共纳入80例连续接受TAVI评估的患者（平均年龄82±6岁）。58例患者（72%）行经股动脉TAVI（使用CoreValve瓣膜），22例患者（28%）行经心尖TAVI（使用Edwards SAPIEN瓣膜）。评估患者特征以及房室传导阻滞（AV）、右束支传导阻滞（RBBB）和左束支传导阻滞（LBBB）的发生频率，以预测TAVI后PM植入情况。此外，使用双源计算机断层扫描计算主动脉瓣钙化（AVC）的阿加斯顿积分，评估主动脉瓣钙化的严重程度及分布情况，包括整个主动脉瓣以及每个瓣叶的情况。
术前有6例患者（8%）存在RBBB，8例患者（10%）存在LBBB。80例患者中有20例（25%）在TAVI后出现新发LBBB。17例TAVI患者（21%；仅为CoreValve瓣膜患者）因完全性AV阻滞（n = 13）或伴有AV延迟的完全性RBBB或LBBB（n = 4）有永久PM植入指征。术前有RBBB的6例患者中有4例（67%）在TAVI后接受了PM植入。多因素logistic回归分析显示，仅假体类型（r = 0.30，p = 0.01）和术前RBBB（r = 0.4，p = 0.02）与TAVI后永久PM植入需求显著相关。
TAVI常伴有新发传导障碍。CoreValve瓣膜系统的新发LBBB及永久PM需求发生率更高。AVC的严重程度或分布与TAVI后PM植入需求之间无关联。术前有RBBB的患者被认为在TAVI后有PM植入风险。
