Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
JACC Cardiovasc Interv. 2019 Jan 14;12(1):52-61. doi: 10.1016/j.jcin.2018.10.053.
The aim of this study was to assess mortality and rehospitalization in patients with new bundle branch block (BBB) and/or permanent pacemaker (PPM) after transcatheter aortic valve replacement (TAVR).
Previous studies have provided inconsistent results on the clinical impact of new BBB or new PPM after TAVR.
A total of 816 consecutive patients without pre-procedural BBB or PPM undergoing TAVR between 2007 and 2017 were followed for 5 years or until data extraction in September 2017. Data on vital status and hospitalization were obtained through national registries.
Within 30 days post-TAVR, new BBB without PPM and new PPM occurred in 247 (30.3%) and 132 (16.2%) patients, respectively, leaving 437 patients (53.6%) without conduction abnormalities. Median follow-up was 2.5 years (interquartile range: 1.0 to 4.9 years). One-year all-cause mortality was increased for new BBB (hazard ratio [HR]: 2.80; 95% confidence interval [CI]: 1.18 to 3.67) but not for new PPM (HR: 1.64; 95% CI: 0.72 to 3.74) compared with patients with no conduction abnormalities. The risk for late all-cause mortality (≥1 year after TAVR) was higher both for patients with new BBB (HR: 1.79; 95% CI: 1.24 to 2.59) and for those with new PPM (HR: 1.58; 95% CI: 1.01 to 2.46) compared with patients with no conduction abnormalities. Patients with new BBB (HR: 1.47; 95% CI: 1.02 to 2.12) and new PPM (HR: 1.66; 95% CI: 1.09 to 2.54) had a higher risk for heart failure hospitalization and reduced left ventricular ejection fraction (p < 0.0001 for both groups) during follow-up.
New BBB and new PPM developed frequently after TAVR. New BBB was associated with increased early and late all-cause mortality, whereas new PPM was associated with late all-cause mortality. Furthermore, both new BBB and new PPM increased the risk for heart failure hospitalizations.
本研究旨在评估经导管主动脉瓣置换术（TAVR）后新发束支传导阻滞（BBB）和/或永久性起搏器（PPM）患者的死亡率和再入院率。
先前的研究对 TAVR 后新发 BBB 或新 PPM 的临床影响提供了不一致的结果。
共纳入 816 例 2007 年至 2017 年间行 TAVR 且术前无 BBB 或 PPM 的连续患者，随访 5 年或直至 2017 年 9 月数据提取。通过国家登记处获取生存状态和住院数据。
TAVR 后 30 天内，新发无 PPM 的 BBB 和新发 PPM 分别发生在 247 例（30.3%）和 132 例（16.2%）患者中，其余 437 例（53.6%）患者无传导异常。中位随访时间为 2.5 年（四分位距：1.0 至 4.9 年）。新发 BBB 患者的 1 年全因死亡率升高（风险比 [HR]：2.80；95%置信区间 [CI]：1.18 至 3.67），但新发 PPM 患者（HR：1.64；95% CI：0.72 至 3.74）则无此变化。与无传导异常患者相比，新发 BBB （HR：1.79；95% CI：1.24 至 2.59）和新发 PPM （HR：1.58；95% CI：1.01 至 2.46）患者的晚期全因死亡率（TAVR 后≥1 年）风险更高。新发 BBB （HR：1.47；95% CI：1.02 至 2.12）和新发 PPM （HR：1.66；95% CI：1.09 至 2.54）患者在随访期间因心力衰竭住院和左心室射血分数降低的风险更高（两组 p 值均<0.0001）。
TAVR 后新发 BBB 和 PPM 较为常见。新发 BBB 与早期和晚期全因死亡率升高相关，而新发 PPM 则与晚期全因死亡率升高相关。此外，新发 BBB 和新发 PPM 均增加心力衰竭住院的风险。
