George Washington University Hospital, Washington, District of Columbia.
George Washington University Hospital, Washington, District of Columbia.
Am J Cardiol. 2019 Jun 1;123(11):1845-1852. doi: 10.1016/j.amjcard.2019.02.050. Epub 2019 Mar 13.
Transcatheter aortic valve implantation (TAVI) is an acceptable treatment for severe aortic stenosis in high or intermediate risk patients. Conduction abnormalities are a known complication of TAVI. Most abnormalities occur perioperatively but can develop later. The predictors of delayed conduction abnormalities are unknown. Patients who underwent TAVI at our institution were reviewed. Patients with a pre-existing pacemaker were excluded. Baseline, in-hospital, and 30-day follow-up ECGs were reviewed. Patient and procedural characteristics were analyzed to look for predictors of acute and delayed abnormalities. Ninety-eight patients were included. All valves implanted were balloon expandable, most commonly SAPIEN S3 (78%). Thirty-seven (37.7%) patients developed abnormalities before discharge. Of these patients, 20 (57.1%) had complete resolution at 30-day follow-up. No patients with new conduction abnormalities during hospitalization had additional abnormalities at 30-day follow-up. Five (5.1%) patients developed new conduction abnormalities following discharge. Overall, 22 (22.4%) patients had conduction abnormalities at 30-day follow-up which were not present at baseline. Predilatation (p = 0.003), higher ratios of balloon (p = 0.03) or valve (p = 0.05) size to left ventricular outflow tract, and previous myocardial infarction (p = 0.034) were predictive of acute conduction abnormalities. Baseline right bundle branch block (p = 0.002), longer baseline (p <0.001) and discharge (p = 0.004) QRS duration, moderate, or severe aortic insufficiency (p = 0.002) and atrial fibrillation (p = 0.031) were predictors of new conduction abnormalities after discharge. In conclusion, most new in-hospital conduction abnormalities resolve by 30-day follow-up. In-hospital conduction abnormalities are related to technical aspects of TAVI while delayed conduction abnormalities are related to baseline conduction system disease.
经导管主动脉瓣植入术（TAVI）是治疗高危或中危重度主动脉瓣狭窄的一种可行方法。传导异常是 TAVI 的已知并发症。大多数异常发生在围手术期，但也可能在后期出现。导致延迟性传导异常的预测因素尚不清楚。我们回顾了在我院接受 TAVI 的患者。排除了术前已装有起搏器的患者。回顾了基线、住院期间和 30 天随访的心电图。分析了患者和手术特点，以寻找急性和延迟性异常的预测因素。共纳入 98 例患者。植入的所有瓣膜均为球囊扩张型，最常见的是 SAPIEN S3（78%）。37 例（37.7%）患者在出院前出现异常。其中 20 例（57.1%）在 30 天随访时完全恢复正常。住院期间出现新传导异常的患者在 30 天随访时无进一步异常。5 例（5.1%）患者在出院后出现新的传导异常。总体而言，22 例（22.4%）患者在 30 天随访时出现了基线时不存在的传导异常。预扩张（p=0.003）、球囊（p=0.03）或瓣膜（p=0.05）与左心室流出道的比值较高，以及既往心肌梗死（p=0.034）是急性传导异常的预测因素。基线右束支传导阻滞（p=0.002）、较长的基线（p<0.001）和出院时（p=0.004）QRS 持续时间、中度或重度主动脉瓣关闭不全（p=0.002）和心房颤动（p=0.031）是出院后出现新的传导异常的预测因素。总之，大多数新出现的院内传导异常在 30 天随访时得到解决。院内传导异常与 TAVI 的技术方面有关，而延迟性传导异常与基线传导系统疾病有关。
