Okuyama Kazuaki, Izumo Masaki, Sasaki Kenichi, Kuwata Shingo, Kaihara Toshiki, Watanabe Mika, Koga Masashi, Kamijima Ryo, Takano Makoto, Ishibashi Yuki, Tanabe Yasuhiro, Higuma Takumi, Harada Tomoo, Akashi Yoshihiro J
Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, 216-8511, Japan.
J Invasive Cardiol. 2020 Oct;32(10):400-404. doi: 10.25270/jic/20.00076.
Atrioventricular block is a common complication of transcatheter aortic valve implantation (TAVI). Although conventional transvenous dual-chamber (DDD) pacemaker (PM) is ideal for atrioventricular block, leadless PM, which is less invasive, may be suitable for frail TAVI patients. Little is known about clinical outcomes of this newer device following TAVI.
A total of 330 consecutive patients undergoing TAVI were reviewed. Of these, PM cases without atrial fibrillation were studied. Indication for leadless PM was based on heart team discussion.
PM implantations were performed in 30 patients (9.1%), and 24 patients (7.3%) had no atrial fibrillation. These 24 patients had 14 DDD-PMs and 10 leadless PMs, and formed the two study groups. Baseline characteristics were similar except for ejection fraction: median ages were 83.0 years (IQR, 81.0-87.0 years) vs 86.5 years (IQR, 83.5-90.3) (P=.18); 11 (78.6%) vs 8 (80%) were women (P=.67); Society of Thoracic Surgeons scores were 5.1% (IQR, 3.8%-5.9%) vs 5.3% (IQR, 3.4%-8.5%) (P=.82); and ejection fractions were 68.0% (IQR, 66.0%-70.5%) vs 59.0% (IQR, 52.8%-69.3%) (P=.049), for the DDD-PM and leadless PM groups, respectively. There was 1 case of atrial lead dislodgment in the DDD-PM group; otherwise, no complications related to the implantation procedure were found. The leadless PM group showed numerically shorter hospital stay: 12.5 days (range, 9.0-17.8 day) in the DDD-PM group vs 10.5 days (range, 7.8-15.3 days) in the leadless PM group (P=.44). Six-month follow-up revealed no significant differences in incidence of heart failure rehospitalizations or deaths: 2 (14.3%) in the DDD-PM group vs 2 (25%) in the leadless PM group (P=.47); and 2 (14.3%) in the DDD-PM group vs 0 (0%) in the leadless PM group (P=.39), respectively.
Patients with leadless PM following TAVI may have shorter hospital stays, and clinical outcomes can be comparable with DDD-PMs. Leadless PMs may therefore be a reasonable option for frail TAVI patients.
房室传导阻滞是经导管主动脉瓣植入术（TAVI）的常见并发症。尽管传统的经静脉双腔（DDD）起搏器（PM）对房室传导阻滞是理想选择，但侵入性较小的无导线PM可能适用于体弱的TAVI患者。关于这种新型装置在TAVI后的临床结果知之甚少。
对连续330例行TAVI的患者进行回顾。其中，研究了无房颤的PM病例。无导线PM的植入指征基于心脏团队讨论。
30例患者（9.1%）植入了PM，24例患者（7.3%）无房颤。这24例患者中有14例植入了DDD-PM，10例植入了无导线PM，形成了两个研究组。除射血分数外，基线特征相似：DDD-PM组和无导线PM组的中位年龄分别为83.0岁（四分位间距，81.0 - 87.0岁）和86.5岁（四分位间距，83.5 - 90.3岁）（P = 0.18）；女性分别为11例（78.6%）和8例（80%）（P = 0.67）；胸外科医师协会评分分别为5.1%（四分位间距，3.8% - 5.9%）和5.3%（四分位间距，3.4% - 8.5%）（P = 0.82）；射血分数分别为68.0%（四分位间距，66.0% - 70.5%）和59.0%（四分位间距，52.8% - 69.3%）（P = 0.049）。DDD-PM组有1例心房导线脱位；除此之外，未发现与植入手术相关的并发症。无导线PM组的住院时间在数值上较短：DDD-PM组为12.5天（范围，9.0 - 17.8天），无导线PM组为10.5天（范围，7.8 - 15.3天）（P = 0.44）。6个月随访显示，心力衰竭再住院率或死亡率无显著差异：DDD-PM组为2例（14.3%），无导线PM组为2例（25%）（P = 0.47）；DDD-PM组为2例（14.3%），无导线PM组为0例（0%）（P = 0.39）。
TAVI后植入无导线PM的患者住院时间可能较短，临床结果与DDD-PM相当。因此，无导线PM可能是体弱TAVI患者的合理选择。
