Department of Cardiology, Hôpital Henri Mondor, Assistance Publique Hôpitaux de Paris and INSERM U 955, 51 Avenue du Maréchal de Lattre de Tassigny, Creteil, France.
Catheter Cardiovasc Interv. 2013 Apr;81(5):882-7. doi: 10.1002/ccd.24657. Epub 2012 Dec 3.
To identify clinical and electrical factors predicting delayed high-degree atrio-ventricular block (AVB) after transcatheter aortic valve implantation (TAVI).
TAVI is a new technique for treating severe aortic valve stenosis in patients at high surgical risk but can be followed by high-grade AVB requiring permanent pacing (PP).
The study included 79 patients (82 ± 17 years, Euroscore = 23% ± 10%) free of PP need before and immediately after TAVI procedure. Delayed high-degree AVB was defined by types 2 or 3 AVB diagnosed at least 24 hr after the index procedure. Permanent pacemaker implantation was performed for all these patients. We compared clinical and electrical variables before and after TAVI in patients with delayed AVB or not. TAVI was performed successfully in all patients. The 21 (26%) patients who exhibited delayed high-grade AVB had significantly deeper prosthesis implantation (12 ± 4 mm vs. 9 ± 5 mm, P = 0.03) and wider post-TAVI QRS duration (155 ± 17 msec vs. 131 ± 25 msec, P = 0.0004), with no difference in baseline QRS duration. Post-TAVI QRS duration was the only independent predictor of post-TAVI permanent for delayed high-degree AVB (P = 0.02). After a mean follow-up of 10 ± 8 months, all 21 patients with post-TAVI QRS ≤ 128 msec were free of high-grade AVB, whereas 21/55 (38%) patients with post-TAVI QRS >128 msec had PP (P = 0.0016).
Delayed (>24 hr after the procedure) high-grade AVB necessitating PP is common after TAVI. QRS duration measured immediately after TAVI was the best independent predictor of PP in this population. Patients with QRS ≤ 128 msec immediately after TAVI had no risk of requiring PP.
确定经导管主动脉瓣置换术（TAVI）后发生迟发性高度房室传导阻滞（AVB）的临床和电生理预测因素。
TAVI 是一种治疗高危外科手术的严重主动脉瓣狭窄的新技术，但可能导致需要永久性起搏（PP）的高级别 AVB。
该研究纳入 79 例患者（82 ± 17 岁，Euroscore = 23% ± 10%），TAVI 术前和术后即刻均无需 PP。迟发性高度 AVB 定义为指数术后至少 24 小时诊断的 2 型或 3 型 AVB。所有这些患者均进行了永久性起搏器植入。我们比较了迟发性 AVB 患者与非迟发性 AVB 患者的 TAVI 前后临床和电生理变量。所有患者均成功完成 TAVI。21 例（26%）患者出现迟发性高度 AVB，其假体植入深度明显更深（12 ± 4mm 比 9 ± 5mm，P = 0.03），TAVI 后 QRS 持续时间更宽（155 ± 17msec 比 131 ± 25msec，P = 0.0004），但基线 QRS 持续时间无差异。TAVI 后 QRS 持续时间是迟发性高度 AVB 后 TAVI 永久性的唯一独立预测因素（P = 0.02）。平均 10 ± 8 个月的随访后，所有 TAVI 后 QRS ≤ 128msec 的 21 例患者均无高级别 AVB，而 TAVI 后 QRS >128msec 的 21/55（38%）例患者需要 PP（P = 0.0016）。
TAVI 后需要 PP 的迟发性（术后 >24 小时）高级别 AVB 较为常见。TAVI 后即刻测量的 QRS 持续时间是该人群中预测 PP 的最佳独立指标。TAVI 后即刻 QRS ≤ 128msec 的患者无需要 PP 的风险。
