Department of Internal Medicine, Division of Cardiology, Washington Hospital Center, Washington, DC, USA.
Am J Cardiol. 2011 Nov 1;108(9):1311-5. doi: 10.1016/j.amjcard.2011.06.049. Epub 2011 Aug 18.
Disturbances in atrioventricular conduction are well-recognized complications of transcatheter aortic valve replacement. Percutaneous balloon aortic valvuloplasty (BAV) is a requisite step in transcatheter aortic valve replacement; however, the contribution of the BAV to atrioventricular conduction disturbances has not been elucidated. The present analysis was undertaken to ascertain the incidence and type of electrocardiographic changes associated with BAV and to consider the role of BAV in the conduction abnormalities after transcatheter aortic valve replacement. In 271 consecutive patients with symptomatic, severe aortic stenosis undergoing BAV, a standard 12-lead electrocardiogram was obtained before and serially after the procedure. Each was examined by experienced electrocardiographers. The cohort was divided into 2 groups with regard to the post-BAV appearance of conduction disturbances. The clinical and procedural characteristics of patients with these disturbances were compared to those in whom no conduction disturbance appeared. After BAV, 23 patients (8.5%) met the study definition of "new conduction defect": 4 patients (1.5%) required permanent pacemaker implantation for advanced atrioventricular block. New left bundle branch block appeared in 9 (3.3%) and left anterior hemiblock in 7 (2.6%). New right bundle branch block appeared in 2 and left posterior hemiblock in 1. No significant difference was found in the clinical or procedural characteristics. The ratio of the balloon size to the left ventricular outflow tract diameter was 1.21 ± 1.6 in those with new conduction defects and 1.15 ± 0.12 (p = 0.032) in those without. In conclusion, BAV is associated with a low incidence of cardiac conduction disturbances and a requirement for permanent ventricular pacing. The size of the valvuloplasty balloon should be carefully selected to avoid oversizing, which can lead to the development of postprocedure conduction disturbances.
房室传导障碍是经导管主动脉瓣置换术的常见并发症。经皮球囊主动脉瓣成形术（BAV）是经导管主动脉瓣置换术的必要步骤；然而，BAV 对房室传导障碍的影响尚未阐明。本分析旨在确定与 BAV 相关的心电图变化的发生率和类型，并探讨 BAV 在经导管主动脉瓣置换术后传导异常中的作用。在 271 例接受 BAV 的有症状、严重主动脉瓣狭窄的连续患者中，在术前和术后连续获得标准 12 导联心电图。每个都由有经验的心电图师检查。根据术后 BAV 出现传导障碍的情况，将队列分为 2 组。比较这些患者与未出现传导障碍患者的临床和程序特征。在 BAV 后，23 例患者（8.5%）符合“新传导缺陷”的研究定义：4 例（1.5%）因严重房室传导阻滞需要植入永久性起搏器。9 例（3.3%）出现新左束支传导阻滞，7 例（2.6%）出现左前分支阻滞。新右束支传导阻滞出现在 2 例，左后分支阻滞出现在 1 例。在临床或程序特征方面无显著差异。新传导缺陷患者的球囊大小与左心室流出道直径的比值为 1.21 ± 1.6，无新传导缺陷患者为 1.15 ± 0.12（p = 0.032）。总之，BAV 与心脏传导障碍的发生率低和需要永久性心室起搏有关。球囊成形术球囊的大小应仔细选择，以避免过大，从而导致术后出现传导障碍。
