Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
JACC Cardiovasc Interv. 2018 Aug 13;11(15):1509-1518. doi: 10.1016/j.jcin.2018.04.011.
The aim of this study was to use a 12-lead electrocardiogram obtained immediately post-transcatheter aortic valve replacement (TAVR) to identify predictors of late high-degree conduction defect (HD-CD) within 30 days after TAVR.
There are limited data on risk factors for the development of late HD-CD and the need to retain the temporary pacemaker after TAVR.
A single-center study was conducted including 467 consecutive patients, without pre-procedural pacemakers, undergoing TAVR.
Self-expandable, mechanical, or balloon-expandable heart valves were implanted in 328 (70%), 61 (13%), and 78 (17%) patients, respectively. For patients in sinus rhythm without right bundle branch block, late HD-CD developed in 0 of 70 patients (0%; 95% confidence interval [CI]: 0% to 5.1%) with PR interval <200 ms and QRS interval <120 ms and in 5 of 109 patients (4.6%; 95% CI: 1.5% to 10.4%; all with sufficient escape rhythm) with PR interval <240 ms and QRS interval <150 ms. Late HD-CD developed in 14 of 101 patients (13.9%; 95% CI: 7.8% to 22.2%; 6 with insufficient escape rhythm [5.9%; 95% CI: 2.2% to 12.5%]) with PR interval ≥240 ms or QRS interval ≥150 ms. Furthermore, late HD-CD developed in 3 of 49 patients (6.1%; 95% CI: 1.3% to 16.9%; all with sufficient escape rhythm) and in 3 of 30 patients (10.0%; 95% CI: 2.1% to 26.5%; 2 with insufficient escape rhythm [6.7%; 95% CI: 0.8% to 22.1%]) with atrial fibrillation and no right bundle branch block with QRS interval <140 and ≥140 ms, respectively.
On the basis of immediate post-TAVR 12-lead electrocardiography, removing the temporary pacemaker immediately following TAVR is potentially safe in patients without right bundle branch block who are: 1) in sinus rhythm with PR interval <240 ms and QRS interval <150 ms; or 2) in atrial fibrillation with a QRS interval <140 ms.
本研究旨在通过经导管主动脉瓣置换术（TAVR）后即刻获得的 12 导联心电图，确定 TAVR 后 30 天内发生迟发性高度传导障碍（HD-CD）的预测因素。
目前关于迟发性 HD-CD 发展的危险因素以及 TAVR 后是否需要保留临时起搏器的数据有限。
本研究为单中心研究，共纳入 467 例连续患者，均无术前起搏器，行 TAVR 治疗。
在窦性节律且无右束支传导阻滞的患者中，PR 间期<200ms 和 QRS 间期<120ms 的 70 例患者（0%；95%置信区间[CI]：0%至 5.1%）和 PR 间期<240ms 和 QRS 间期<150ms 的 109 例患者（4.6%；95%CI：1.5%至 10.4%；均有足够的逸搏节律）中无一例发生迟发性 HD-CD。在 101 例 PR 间期≥240ms 或 QRS 间期≥150ms 的患者中，14 例（13.9%；95%CI：7.8%至 22.2%；其中 6 例无足够的逸搏节律[5.9%；95%CI：2.2%至 12.5%]）发生迟发性 HD-CD。此外，在 49 例 PR 间期<240ms 和 QRS 间期<150ms 的患者中，有 3 例（6.1%；95%CI：1.3%至 16.9%；均有足够的逸搏节律）和 30 例（10.0%；95%CI：2.1%至 26.5%；其中 2 例无足够的逸搏节律[6.7%；95%CI：0.8%至 22.1%]）发生迟发性 HD-CD，其心电图 QRS 间期分别为<140ms 和≥140ms，且均为心房颤动且无右束支传导阻滞。
基于 TAVR 后即刻的 12 导联心电图，如果无右束支传导阻滞且符合以下条件的患者：1）窦性节律，PR 间期<240ms，QRS 间期<150ms；或 2）心房颤动，QRS 间期<140ms，则 TAVR 后立即移除临时起搏器可能是安全的。
