Coeman Mathieu, Kayaert Peter, Philipsen Tine, Calle Simon, Gheeraert Peter, Gevaert Sofie, Czapla Jens, Timmers Liesbeth, Van Heuverswyn Frédéric, De Pooter Jan
Department of Cardiology, Ghent University Hospital, Ghent, Belgium.
Department of Cardiology, Ghent University Hospital, Ghent, Belgium.
J Electrocardiol. 2020 Mar-Apr;59:68-73. doi: 10.1016/j.jelectrocard.2020.01.005. Epub 2020 Jan 23.
New onset electrocardiographic (ECG) changes after transcatheter aortic valve replacement (TAVR) are used to assess the risk for late atrioventricular block. However, the time of ECG evaluation remains controversial. We aimed to compare the time course and dynamics of new onset ECG changes according to valve design in balloon- (BEV) and self-expandable (SEV) TAVR.
This single center study enrolled 133 consecutive TAVR patients (28.6% SEV, 71.4% BEV). Patients with pre-existent permanent pacemaker implant (PPMI), procedural death or incomplete ECG registration were excluded. Standard 12‑lead ECG was performed before the procedure, at 1, 24, 48 and 120 h and 1 month. In BEV patients, no significant PR prolongation occurred, whereas in SEV patients the PR interval prolonged significantly with 33.7 ± 22.0 ms (p < 0.001, compared to pre-TAVR) but only after 48 h after TAVR. Widening of QRS duration was comparable among both BEV and SEV patients (6.7 ± 21.5 versus 17.0 ± 26.9 ms, p = 0.061) and occurred immediately after TAVR. New-onset left bundle branch block was seen in 18.5% of BEV and 30.8% of SEV patients (p = 0.120) and occurred within 24 h after TAVR in both groups. Late PPMI (>24 h after TAVR) was higher in SEV compared to BEV patients (15.3% versus 1.5%, p = 0.008).
Self-expandable valves cause more impairment in atrioventricular conduction with a delayed time course compared to balloon expandable valves. This might explain the higher pacemaker need beyond 24 h after TAVR. Our findings suggest that patients with self-expandable valves require at least 48 h ECG monitoring post TAVR.
经导管主动脉瓣置换术（TAVR）后新出现的心电图（ECG）变化用于评估晚期房室传导阻滞的风险。然而，ECG评估的时间仍存在争议。我们旨在比较球囊扩张式（BEV）和自膨胀式（SEV）TAVR中根据瓣膜设计的新出现ECG变化的时间进程和动态变化。
这项单中心研究纳入了133例连续的TAVR患者（28.6%为SEV，71.4%为BEV）。排除术前已植入永久起搏器（PPMI）、手术死亡或ECG记录不完整的患者。在手术前、术后1、24、48和120小时以及1个月时进行标准12导联ECG检查。在BEV患者中，未出现显著的PR间期延长，而在SEV患者中，PR间期显著延长，延长了33.7±22.0毫秒（与TAVR术前相比，p<0.001），但仅在TAVR术后48小时后出现。BEV和SEV患者的QRS时限增宽相当（6.7±21.5与17.0±26.9毫秒，p=0.061），且在TAVR术后立即出现。18.5%的BEV患者和30.8%的SEV患者出现新发左束支传导阻滞（p=0.120），两组均在TAVR术后24小时内出现。SEV患者的晚期PPMI（TAVR术后>24小时）高于BEV患者（15.3%对1.5%，p=0.008）。
与球囊扩张瓣膜相比，自膨胀瓣膜导致房室传导障碍更多，且时间进程延迟。这可能解释了TAVR术后24小时后起搏器需求更高的原因。我们的研究结果表明，自膨胀瓣膜患者在TAVR术后至少需要48小时的ECG监测。
