Address for correspondence: David Hildick-Smith, MD, Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Eastern Road Brighton, BN2 5BE United Kingdom.
J Invasive Cardiol. 2020 Sep;32(9):347-349. doi: 10.25270/jic/20.00026. Epub 2020 Jul 10.
The need for permanent pacemaker implantation (PPI) following transcatheter aortic valve implantation (TAVI) is a recognized complication due to compression of the cardiac conduction system. PPI rates vary according to type of TAVI device, implantation technique, and patient-related factors.
We analyzed the baseline characteristics, and then the preprocedure and daily postprocedure electrocardiograms (ECGs) of 101 consecutive patients who underwent TAVI using the Lotus valve (Boston Scientific) between 2013 and 2015.
Mean patient age was 81.7 ± 7.7 years, 56% were male. and 21 patients were excluded because of baseline atrial fibrillation or a pre-existing PPI. Of the remaining 80 patients, a total of 28 (35%) underwent PPI at a mean 2.7 days after TAVI. There were no differences in development of new left bundle-branch block between the two groups (65% PPI group vs 74% no-PPI group; P=.37). The initial PR interval did not differ between groups (183 ms PPI group vs 184 ms no-PPI group). The PR interval increased by day 1 post procedure (232 ms PPI group vs 195 ms no-PPI group; P<.01) and day 2 (267 ms PPI group vs 211 ms no-PPI group; P<.05).
Patients with a PR interval ≤230 ms on day 1 or ≤260 ms on day 2 post TAVI using the Lotus device are at very low risk of requiring PPI, irrespective of the presence of left bundle-branch block, and can be safely discharged without prolonged monitoring.
经导管主动脉瓣植入（TAVI）后需要植入永久性起搏器（PPI），这是一种公认的并发症，其原因是心脏传导系统受压。PPI 的发生率因 TAVI 装置的类型、植入技术以及患者相关因素而异。
我们分析了 2013 年至 2015 年间使用 Lotus 瓣膜（波士顿科学公司）连续进行 TAVI 的 101 例患者的基线特征，以及术前和术后每日心电图（ECG）。
患者平均年龄为 81.7±7.7 岁，56%为男性。21 例患者因基线心房颤动或预先存在的 PPI 而被排除在外。在其余 80 例患者中，共有 28 例（35%）在 TAVI 后平均 2.7 天接受了 PPI。两组新发左束支传导阻滞的发生率无差异（PPI 组 65%，无 PPI 组 74%；P=.37）。两组的初始 PR 间期无差异（PPI 组 183 ms，无 PPI 组 184 ms）。术后第 1 天 PR 间期增加（PPI 组 232 ms，无 PPI 组 195 ms；P<.01），第 2 天增加（PPI 组 267 ms，无 PPI 组 211 ms；P<.05）。
在使用 Lotus 装置进行 TAVI 后，第 1 天 PR 间期≤230 ms 或第 2 天 PR 间期≤260 ms 的患者，无论是否存在左束支传导阻滞，发生 PPI 的风险都非常低，可以安全出院，无需延长监测。
