Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada.
Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada.
Am J Cardiol. 2020 Jan 1;125(1):107-113. doi: 10.1016/j.amjcard.2019.09.047. Epub 2019 Oct 15.
The objective of this study was to determine the long-term (>1 year) electrocardiographic (ECG) and clinical outcomes of patients without significant changes in their electrocardiogram after transcatheter aortic valve implantation (TAVI; including patients with pre-existing ECG abnormalities). Among 772 consecutive patients who underwent TAVI in our institution, 397 patients (51%) without new ECG changes were included. TAVI patients were divided into 2 groups according to the presence of pre-existing ECG-conduction disturbances (ECG-CD: 140 patients, non-ECG-CD: 257 patients). Clinical follow-up (median: 35 [22 to 57] months) was complete in all patients but 5 (1.2%), and ECG data were available in 291 patients (84.3% of patients at risk) at a median of 29 (20 to 50) months. In the non-ECG-CD group, most patients (79.8%) remained without significant ECG changes at follow-up, and 16.9% developed first-degree atrioventricular block and/or bundle branch block over time. The rate of permanent pacemaker (PPM) implantation at follow-up was 3.5% (1.1%/year) in the non-ECG-CD group versus 15.7% (5.5%/year) in the ECG-CD group (p <0.001). The presence of pre-existing CD was an independent predictor of PPM at follow-up (hazard ratio [HR] 4.67, 95% confidence interval [CI] 2.15 to 10.16, p <0.001). The ECG-CD group exhibited a higher risk of heart failure hospitalization (non-ECG-CD: 25%, ECG-CD: 29%, log-rank p = 0.01), but not mortality (non-ECG-CD: 50%, ECG-CD: 46%, log-rank p = 0.60) at 5-year follow-up. In conclusion, the ECG remained unchanged in most TAVI recipients without new postprocedural CD. Pre-existing ECG-CD was associated with an increased risk of PPM and heart failure hospitalization at long-term follow-up. These results provide reassuring data in the era of TAVI expanding toward candidates with a longer life expectancy, and highlight the importance of a closer follow-up of those patients with pre-existing ECG-CDs.
本研究旨在确定经导管主动脉瓣置换术（TAVI）后心电图（ECG）无明显变化（包括术前存在 ECG 异常的患者）的患者的长期（>1 年）心电图和临床结局。在我院接受 TAVI 的 772 例连续患者中，纳入了 397 例（51%）无新 ECG 变化的患者。根据术前存在 ECG 传导障碍（ECG-CD：140 例，非 ECG-CD：257 例），将 TAVI 患者分为 2 组。所有患者均完成了临床随访（中位数：35 [22 至 57] 个月），但有 5 例（1.2%）失访，291 例（风险患者的 84.3%）患者在中位数 29（20 至 50）个月时可获得 ECG 数据。在非 ECG-CD 组中，大多数患者（79.8%）在随访时心电图仍无明显变化，16.9%随时间推移出现一度房室传导阻滞和/或束支传导阻滞。非 ECG-CD 组在随访时安装永久性起搏器（PPM）的发生率为 3.5%（1.1%/年），而 ECG-CD 组为 15.7%（5.5%/年）（p<0.001）。术前存在 CD 是随访时 PPM 的独立预测因素（风险比 [HR] 4.67，95%置信区间 [CI] 2.15 至 10.16，p<0.001）。ECG-CD 组心力衰竭住院风险较高（非 ECG-CD：25%，ECG-CD：29%，log-rank p=0.01），但 5 年随访时死亡率无差异（非 ECG-CD：50%，ECG-CD：46%，log-rank p=0.60）。总之，大多数无新发术后 CD 的 TAVI 受者的 ECG 保持不变。术前存在 ECG-CD 与长期随访时 PPM 和心力衰竭住院风险增加相关。这些结果在 TAVI 向预期寿命更长的患者扩展的时代提供了令人安心的数据，并强调了对那些术前存在 ECG-CDs 的患者进行更密切随访的重要性。
