Rivard Lena, Schram Gernot, Asgar Anita, Khairy Paul, Andrade Jason G, Bonan Raoul, Dubuc Marc, Guerra Peter G, Ibrahim Reda, Macle Laurent, Roy Denis, Talajic Mario, Dyrda Katia, Shohoudi Azadeh, le Polain de Waroux Jean-Benoit, Thibault Bernard
Department of Cardiology at the Montreal Heart Institute and the Université de Montréal, Montreal, Canada.
Department of Cardiology at the Montreal Heart Institute and the Université de Montréal, Montreal, Canada.
Heart Rhythm. 2015 Feb;12(2):321-9. doi: 10.1016/j.hrthm.2014.10.023. Epub 2014 Oct 31.
Electrophysiological predictors of atrioventricular (AV) block after transcatheter aortic valve replacement (TAVR) are unknown.
We sought to assess the value of electrophysiology study before and after TAVR.
Seventy-five consecutive pacemaker-free patients undergoing TAVR at the Montreal Heart Institute were prospectively studied.
Eleven patients (14.7%) developed AV block during the index hospitalization and 3 (4.0%) after hospital discharge over a median follow-up of 1.4 years (interquartile range 0.6-2.1 years). AV block developed in 5 of 6 patients with preprocedural right bundle branch block (83.3%), 8 of 30 patients with new-onset left bundle branch block (LBBB; 26.7%), and 1 of 7 patients with preexisting LBBB (14.3%). In multivariate analysis that considered all patients, the delta-HV interval (HV interval after TAVR minus HV interval before TAVR) was the only factor independently associated with AV block. In the subgroup of patients with new-onset LBBB, the postprocedural HV interval was strongly associated with AV block. By receiver operating characteristic analysis, a delta-HV interval of ≥13 ms predicted AV block with 100.0% sensitivity and 84.4% specificity and an HV interval of ≥65 ms predicted AV block with 83.3% sensitivity and 81.6% specificity. In multivariate analysis, the HV interval after TAVR (hazard ratio 1.073 per ms; 95% confidence interval 1.029-1.119; P = .001) was also independently associated with all-cause mortality.
A prolonged delta-HV interval (≥13 ms) is strongly associated with AV block after TAVR. In patients with new-onset LBBB after TAVR, a postprocedural HV interval of ≥65 ms is likewise predictive of AV block.
经导管主动脉瓣置换术（TAVR）后房室（AV）传导阻滞的电生理预测因素尚不清楚。
我们试图评估TAVR前后电生理检查的价值。
对蒙特利尔心脏研究所连续75例未植入起搏器且接受TAVR的患者进行前瞻性研究。
在中位随访1.4年（四分位间距0.6 - 2.1年）期间，11例患者（14.7%）在首次住院期间发生AV传导阻滞，3例患者（4.0%）在出院后发生AV传导阻滞。6例术前存在右束支传导阻滞的患者中有5例（83.3%）发生AV传导阻滞，30例新发左束支传导阻滞（LBBB）的患者中有8例（26.7%）发生AV传导阻滞，7例既往存在LBBB的患者中有1例（14.3%）发生AV传导阻滞。在纳入所有患者的多变量分析中，HV间期差值（TAVR后HV间期减去TAVR前HV间期）是与AV传导阻滞独立相关的唯一因素。在新发LBBB患者亚组中，术后HV间期与AV传导阻滞密切相关。通过受试者工作特征分析，HV间期差值≥13 ms预测AV传导阻滞的敏感度为100.0%，特异度为84.4%；HV间期≥65 ms预测AV传导阻滞的敏感度为83.3%，特异度为81.6%。在多变量分析中，TAVR后的HV间期（每毫秒风险比1.073；95%置信区间1.029 - 1.119；P = .001）也与全因死亡率独立相关。
HV间期差值延长（≥13 ms）与TAVR后AV传导阻滞密切相关。在TAVR后新发LBBB的患者中，术后HV间期≥65 ms同样可预测AV传导阻滞。
