Leviev Heart Center, Sheba Medical Center, Ramat Gan, Israel
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
J Am Heart Assoc. 2018 Jul 9;7(14):e009038. doi: 10.1161/JAHA.118.009038.
Rapid ventricular pacing (RVP) is used commonly during transcatheter aortic valve replacement (TAVR). Little is known about the safety and clinical consequences of this step. The aim of this study was to assess the impact of RVP on immediate and long-term clinical outcomes in a large cohort of non-selected TAVR patients.
The study included 412 consecutive patients undergoing TAVR with a mean age of 82±7 years, of which 47% were male. Patients were divided according to the number of RVPs during the TAVR procedure comparing patients undergoing no pacing (0), 1 to 2, and ≥3 pacing episodes (3+). Patients undergoing 3+ pacing episodes were significantly more likely to develop new atrial fibrillation (5.6% versus 7.3% versus 15%, respectively, for 0, 1-2, and 3+ groups, =0.047), acute kidney injury (AKI) (18% versus 18% versus 28%, respectively, <0.001), prolonged procedural hypotension (0%, 16%, and 25%, respectively; <0.001), and suffered greater in-hospital mortality (1.7%, 1.7%, and 6.5%, respectively, =0.045), and 1-year mortality (11.1%, 7.7%, and 18%, respectively, =0.015). Multivariate Cox regression analysis indicated that acute kidney injury (OR 3.27 [1.763-6.09], <0.001), euroSCORE II (OR 1.06 per unit [1.01-1.12], =0.03), and 3+ pacing episodes (OR 2.35 [1.18-4.7], =0.02) were the only independent predictors for 1-year mortality.
In patients undergoing TAVR, multiple RVP episodes and prolonged RVP duration are associated with adverse outcomes including short- and long-term mortality. Thus, operators should attempt to minimize the use of RVP, especially in patients who are at risk for post-procedural acute kidney injury.
在经导管主动脉瓣置换术（TAVR）期间，常使用快速心室起搏（RVP）。关于这一步骤的安全性和临床后果知之甚少。本研究旨在评估在大量非选择性 TAVR 患者中，RVP 对即刻和长期临床结局的影响。
这项研究纳入了 412 例连续接受 TAVR 的患者，平均年龄 82±7 岁，其中 47%为男性。根据 TAVR 过程中进行的 RVP 次数将患者分为 3 组：无起搏（0）、1-2 次起搏和≥3 次起搏（3+）。进行 3+次起搏的患者发生新发心房颤动的可能性显著更高（分别为 5.6%、7.3%和 15%，0、1-2 和 3+组，=0.047）、急性肾损伤（AKI）（分别为 18%、18%和 28%，<0.001）、手术过程中低血压持续时间更长（分别为 0%、16%和 25%，<0.001），院内死亡率更高（分别为 1.7%、1.7%和 6.5%，=0.045），1 年死亡率也更高（分别为 11.1%、7.7%和 18%，=0.015）。多变量 Cox 回归分析表明，急性肾损伤（OR 3.27[1.763-6.09]，<0.001）、欧洲心脏手术风险评估系统 II 评分（OR 每增加 1 单位[1.01-1.12]，=0.03）和 3+次起搏（OR 2.35[1.18-4.7]，=0.02）是 1 年死亡率的唯一独立预测因素。
在接受 TAVR 的患者中，多次 RVP 发作和长时间 RVP 持续时间与不良结局相关，包括短期和长期死亡率。因此，操作人员应尽量减少 RVP 的使用，特别是在有术后急性肾损伤风险的患者中。
