Department of Internal Medicine II, Paracelsus Medical University, Salzburg, Austria.
Ann Thorac Surg. 2012 Jan;93(1):124-31. doi: 10.1016/j.athoracsur.2011.08.078. Epub 2011 Nov 23.
Transcatheter aortic valve implantation (TAVI) represents an alternative option for elderly patients with severe aortic valve stenosis who are denied surgical aortic valve replacement (SAVR) because of high perioperative risk. The impact of TAVI on postprocedural atrial fibrillation is undefined.
In a single-center analysis, we assessed clinical data, preoperative risk scores (Society for Thoracic Surgeons score, logistic European System for Cardiac Operative Risk Evaluation), preprocedural electrocardiograms, and 72-hour postprocedural rhythm monitoring of 170 patients undergoing TAVI (n=84) or SAVR (n=86). In a subanalysis, transapical (n=43) and transfemoral TAVI (n=41) were compared.
Expectedly, TAVI patients were significantly older, presented with more severe symptoms, had higher Society for Thoracic Surgeons score, higher logistic European System for Cardiac Operative Risk Evaluation score, and revealed more frequently intermittent atrial fibrillation compared with SAVR patients. Despite this more compromised health state, prevalence of postprocedural atrial fibrillation was significantly lower in the TAVI group (6.0%, versus 33.7% after SAVR, p<0.05). More than two thirds of TAVI patients but no SAVR patient with atrial fibrillation in preprocedural electrocardiograms had stable sinus rhythm during 72-hour postprocedural monitoring. Notably, no atrial fibrillation was observed after transfemoral TAVI. Whereas atrial fibrillation onset in the SAVR group predominantly occurred on postoperative day 3, atrial fibrillation onset after transapical TAVI was obtained within the first 24 hours after the intervention.
Our results indicate that TAVI, compared with SAVR, reduces the risk of periprocedural atrial fibrillation. Furthermore, preprocedural atrial fibrillation may be converted into sinus rhythm particularly after transfemoral TAVI, suggesting an impact of decreased intracardiac pressures in the absence of adverse periprocedural factors that might promote atrial fibrillation.
经导管主动脉瓣植入术（TAVI）为因围手术期风险高而被拒绝接受外科主动脉瓣置换术（SAVR）的老年重度主动脉瓣狭窄患者提供了另一种选择。TAVI 对术后心房颤动的影响尚不清楚。
在单中心分析中，我们评估了 170 例接受 TAVI（n=84）或 SAVR（n=86）的患者的临床数据、术前风险评分（胸外科医师协会评分、逻辑欧洲心脏手术风险评估系统）、术前心电图和 72 小时术后节律监测。在亚分析中，比较了经心尖（n=43）和经股动脉 TAVI（n=41）。
意料之中的是，TAVI 患者年龄明显更大，症状更严重，胸外科医师协会评分、逻辑欧洲心脏手术风险评估系统评分更高，且与 SAVR 患者相比，间歇性心房颤动更为常见。尽管健康状况更差，但 TAVI 组的术后心房颤动发生率明显较低（6.0%，而 SAVR 组为 33.7%，p<0.05）。TAVI 组中超过三分之二的术前心电图有房颤的患者在 72 小时术后监测期间保持窦性心律，但没有 SAVR 患者出现这种情况。值得注意的是，经股动脉 TAVI 后未观察到房颤。而 SAVR 组的房颤发作主要发生在术后第 3 天，经心尖 TAVI 组的房颤发作发生在介入治疗后 24 小时内。
我们的结果表明，与 SAVR 相比，TAVI 降低了围手术期房颤的风险。此外，术前房颤可能会转化为窦性心律，尤其是在经股动脉 TAVI 后，提示在不存在可能促进房颤的不良围手术期因素的情况下，心内压降低可能会产生影响。
