Department of Cardiology.
Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, the Netherlands.
Am J Cardiol. 2019 Oct 15;124(8):1239-1245. doi: 10.1016/j.amjcard.2019.07.035. Epub 2019 Jul 30.
Long-term evolution of new-onset conduction abnormalities and need of permanent pacemaker implantation (PPI) after transcatheter aortic valve implantation (TAVI) have not been extensively evaluated. We describe the incidence and time course of new conduction abnormalities and the rate of PPI with the new-generation transcatheter aortic valve prosthesis Edwards SAPIEN 3 (S3). In total, 266 patients with severe aortic stenosis who underwent TAVI were retrospectively analyzed. Twelve-lead electrocardiograms at baseline, after TAVI, at discharge, at 1-, 6-, and 12-month follow-up were evaluated to identify conduction abnormalities and PPI requirements to investigate the correlates of PPI. After TAVI, a significant increase in PR interval duration and in QRS complex width was observed. New-onset left bundle branch block was observed in 65 patients (24%) after TAVI. The number of patients with left bundle branch block was maximum at hospital discharge and decreased at 12-month follow-up (39% and 32%, respectively). Thirty-five patients (13%) required PPI during the follow-up. However, paced rhythm was only observed in 7% of the patients with a complete 12-month follow-up. Patients who underwent PPI had a higher prevalence of first-degree atrioventricular block, complete right bundle branch block, and wider QRS complex at baseline. Baseline right bundle branch block and QRS width immediately after TAVI were the only variables independently associated with PPI. In conclusion, conduction disorders have a temporary nature after TAVI and showed a trend toward stabilization during the following months. With this new-generation device, the incidence of new conduction abnormalities requiring PPI is relatively low.
经导管主动脉瓣置换术（TAVI）后新发传导异常的长期演变和永久性起搏器植入（PPI）的需求尚未得到广泛评估。我们描述了新一代经导管主动脉瓣假体爱德华兹 SAPIEN 3（S3）植入后新发传导异常的发生率和时间进程以及 PPI 的发生率。共有 266 例严重主动脉瓣狭窄患者接受了回顾性分析。TAVI 后、出院时、1 个月、6 个月和 12 个月随访时进行 12 导联心电图评估，以确定传导异常和 PPI 需求，以研究 PPI 的相关性。TAVI 后，PR 间期和 QRS 波群宽度显著增加。TAVI 后 65 例（24%）患者新发左束支传导阻滞。左束支传导阻滞的患者数量在出院时最多，在 12 个月随访时减少（分别为 39%和 32%）。35 例（13%）患者在随访期间需要 PPI。然而，在接受完整 12 个月随访的患者中，仅观察到 7%的起搏节律。需要 PPI 的患者在基线时有更高的一度房室传导阻滞、完全右束支传导阻滞和更宽的 QRS 波群的发生率。基线右束支传导阻滞和 TAVI 后即刻的 QRS 宽度是唯一与 PPI 独立相关的变量。总之，TAVI 后传导障碍具有暂时性，在随后的几个月中呈稳定趋势。使用这种新一代器械，需要 PPI 的新发传导异常的发生率相对较低。
