Dept. of Cardiology III - Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Muenster, Germany.
Dept. of Cardiology III - Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Muenster, Germany.
Int J Cardiol. 2018 Dec 15;273:56-62. doi: 10.1016/j.ijcard.2018.07.131. Epub 2018 Jul 26.
To analyze the timing of appearance of conduction abnormalities (CAs) after transcatheter aortic valve implantation (TAVI), to identify predictors of delayed CAs requiring pacemaker (PM) implantation and to provide guidance regarding the duration of telemetry monitoring.
How long patients remain at risk of development of CAs requiring PM implantation after TAVI and for how long they should be monitored remains unclear but is crucial when considering early discharge.
Development of CAs was studied in 701 consecutive patients treated with Edwards Sapien 3 valves and monitored with telemetry for 7 days in a single center. After excluding valve-in-valve procedures and patients with previous PM, 606 patients remained for analysis. Predictors of CAs requiring PM and the time of onset of CAs were analyzed.
Of 606 patients 76 (12.5%) required a PM after TAVI. CAs requiring PM implantation occurred after 48 h in 22.4% (17 patients) and in 10.5% (8 patients) even after 5 days. Of the patients who developed high grade CAs requiring PM after 48 h, 47.1% had no CAs prior to TAVI, and 23.5% had neither pre-existing CAs nor new-developed CAs within the first 48 h after TAVI.
After TAVI using a new-generation balloon-expandable valve, delayed development of CAs requiring PM implantation is not uncommon, even after 5 days. More importantly, 23.5% of patients eventually requiring a delayed PM implantation had still no CAs at 48 h after TAVI in this study. These results question the safety of early discharge and support ECG monitoring for a longer time period. The most optimal way to monitor these patients is yet to be determined.
分析经导管主动脉瓣植入（TAVI）后传导异常（CA）出现的时间，确定需要起搏器（PM）植入的迟发性 CA 的预测因素，并为遥测监测持续时间提供指导。
TAVI 后需要 PM 植入的 CA 发展风险持续时间以及需要监测的时间尚不清楚，但在考虑早期出院时至关重要。
在单中心对 701 例接受 Edwards Sapien 3 瓣膜治疗的连续患者进行 CA 发展研究，并进行 7 天的遥测监测。排除瓣中瓣手术和有既往 PM 的患者后，606 例患者进行分析。分析需要 PM 的 CA 的预测因素和 CA 的发病时间。
606 例患者中有 76 例（12.5%）在 TAVI 后需要 PM。在 22.4%（17 例）和 10.5%（8 例）的患者中，PM 植入需要的 CA 在 48 小时后发生，甚至在 5 天后发生。在 48 小时后发生需要 PM 的高级别 CA 的患者中，47.1%的患者在 TAVI 前无 CA，23.5%的患者在 TAVI 后前 48 小时内既无既往 CA 也无新发 CA。
在使用新一代球囊扩张瓣膜进行 TAVI 后，即使在 5 天后，也并不罕见出现需要 PM 植入的迟发性 CA。更重要的是，在这项研究中，23.5%最终需要迟发性 PM 植入的患者在 TAVI 后 48 小时仍无 CA。这些结果对早期出院的安全性提出了质疑，并支持更长时间的心电图监测。监测这些患者的最佳方法仍有待确定。
