Raelson Colin A, Gabriels James, Ruan Jonathan, Ip James E, Thomas George, Liu Christopher F, Cheung Jim W, Lerman Bruce B, Patel Apoor, Markowitz Steven M
Division of Cardiology, Department of Medicine, Weill Cornell Medical Center, New York, NY, USA.
Northwell Health, Manhasset, NY, USA.
J Cardiovasc Electrophysiol. 2017 Oct;28(10):1196-1202. doi: 10.1111/jce.13291. Epub 2017 Aug 4.
Recovery of conduction has been demonstrated in >50% of patients who receive pacemakers (PPMs) for high-degree atrioventricular block (HD-AVB) after transcatheter aortic valve replacement (TAVR). Little information is available about the time course of conduction recovery in these patients and if any features predict early recovery of conduction.
A retrospective review was performed of patients who underwent TAVR with balloon and self-expanding valves who required PPMs for HD-AVB. Serial PPM interrogations were analyzed to detect recovery of AV conduction. Analysis was performed to identify predictors and timing of conduction recovery.
Of a total population of 578 patients, 54 (9%) received PPMs for HD-AVB. In multivariate analysis, predictors of HD-AVB requiring a PPM included age (P = 0.014), right bundle branch block (OR 7.33 [3.64-14.8], P < 0.0001), atrial fibrillation (OR 2.16 [1.16-4.05], P = 0.016), and self-expanding valves (OR 4.19 [2.20-7.97], P < 0.0001). Of the 54 patients who received PPMs, 38 had follow-up sufficient to evaluate AV conduction recovery. Of these, 23 (61%) showed recovery of AV nodal conduction; 20 had already recovered by their first interrogation, a median of 22 days (IQR 14-31) post-PPM placement. There were no statistically significant predictors of AV nodal conduction recovery, including type of valve implanted.
A majority of patients who receive PPMs for HD-AVB after TAVR recover AV conduction during follow-up, and in most patients conduction recovery occurs within weeks. These findings imply that programming to minimize ventricular pacing may be beneficial in a majority of these patients.
在经导管主动脉瓣置换术（TAVR）后因高度房室传导阻滞（HD-AVB）接受起搏器（PPM）治疗的患者中，超过50%已证实传导功能恢复。关于这些患者传导功能恢复的时间进程以及是否有任何特征可预测传导功能的早期恢复，目前所知甚少。
对接受球囊和自膨胀瓣膜TAVR且因HD-AVB需要PPM的患者进行回顾性研究。分析连续的PPM问询结果以检测房室传导恢复情况。进行分析以确定传导恢复的预测因素和时间。
在578例患者的总体人群中，54例（9%）因HD-AVB接受了PPM。在多变量分析中，需要PPM的HD-AVB的预测因素包括年龄（P = 0.014）、右束支传导阻滞（OR 7.33 [3.64 - 14.8]，P < 0.0001）、心房颤动（OR 2.16 [1.16 - 4.05]，P = 0.016）和自膨胀瓣膜（OR 4.19 [2.20 - 7.97]，P < 0.0001）。在接受PPM的54例患者中，38例有足够的随访时间来评估房室传导恢复情况。其中，23例（61%）显示房室结传导恢复；20例在首次问询时就已恢复，PPM植入后中位数为22天（IQR 14 - 31）。包括植入瓣膜类型在内，没有房室结传导恢复的统计学显著预测因素。
TAVR后因HD-AVB接受PPM治疗的大多数患者在随访期间恢复了房室传导，且大多数患者的传导恢复在数周内发生。这些发现表明，在这些患者中的大多数中，进行编程以尽量减少心室起搏可能是有益的。
