Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland.
J Cardiovasc Electrophysiol. 2012 Oct;23(10):1115-22. doi: 10.1111/j.1540-8167.2012.02354.x. Epub 2012 May 15.
Atrioventricular conduction abnormalities (AVCA) may complicate transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR). The aim of this study was to prospectively evaluate AVCA after TAVI and SAVR.
Among 50 patients undergoing TAVI and 25 patients undergoing SAVR a continuous 7-day Holter electrocardiogram (ECG) was recorded after the procedure. ECGs during TAVI and 12-lead ECGs before and 1 and 7 days after TAVI and SAVR were analyzed. At baseline, TAVI patients were older (mean 82.1 vs 75.4, P < 0.001), had a longer PR interval (median 200 milliseconds vs 175 milliseconds, P = 0.004) and broader QRS width (median 100 milliseconds vs 80 milliseconds, P = 0.007) than SAVR patients. New AVCA were observed among 29 TAVI patients (58%), mostly new left bundle branch block (76%). Predilatation induced new AVCA in 14 TAVI patients (28%). New AVCA resolved within 24 hours in 15 TAVI patients (30%), and persisted in 14 TAVI (28%) and 3 SAVR patients (12%, P = 0.12). Among patients with persistent QRS width <120 milliseconds during the first 24 hours after TAVI, QRS width remained stable during the remainder of the observation period. During Holter monitoring complete AV block was observed in 4 TAVI patients (8%) and 3 SAVR patients (12%; P = 0.68).
Almost half of AVCA during TAVI are induced by predilatation, but half of them resolve within 24 hours. Persistent AVCA are more frequently observed after TAVI than SAVR. If QRS width is below 120 milliseconds the first day after TAVI, the risk of late AVCA seems low.
房室传导异常（AVCA）可能使经导管主动脉瓣植入术（TAVI）和外科主动脉瓣置换术（SAVR）复杂化。本研究旨在前瞻性评估 TAVI 和 SAVR 后的 AVCA。
在 50 例接受 TAVI 和 25 例接受 SAVR 的患者中，术后连续记录 7 天动态心电图（ECG）。分析 TAVI 期间和 TAVI 及 SAVR 前、后 1 天和 7 天的 12 导联 ECG。基线时，TAVI 患者年龄较大（平均 82.1 岁 vs 75.4 岁，P<0.001），PR 间期较长（中位数 200 毫秒 vs 175 毫秒，P=0.004），QRS 宽度较宽（中位数 100 毫秒 vs 80 毫秒，P=0.007）。29 例 TAVI 患者（58%）出现新发 AVCA，主要为新发左束支传导阻滞（76%）。14 例 TAVI 患者（28%）行预扩张术诱发新的 AVCA。15 例 TAVI 患者（30%）的新 AVCA 在 24 小时内缓解，14 例 TAVI（28%）和 3 例 SAVR 患者（12%）持续存在（P=0.12）。在 TAVI 后前 24 小时 QRS 宽度<120 毫秒的患者中，有 14 例（28%）持续存在 QRS 宽度<120 毫秒，其余患者 QRS 宽度在观察期间保持稳定。在动态心电图监测期间，4 例 TAVI 患者（8%）和 3 例 SAVR 患者（12%）发生完全性房室传导阻滞（P=0.68）。
TAVI 期间几乎一半的 AVCA 是由预扩张引起的，但其中一半在 24 小时内缓解。TAVI 后持续存在的 AVCA 比 SAVR 更常见。如果 TAVI 后第一天 QRS 宽度<120 毫秒，晚期 AVCA 的风险似乎较低。
