Department of Cardiology Hospital General Universitario Gregorio Marañón CIBERCV Madrid Spain.
Department of Cardiology Hospital General Universitario 12 de Octubre CIBERCV Madrid Spain.
J Am Heart Assoc. 2020 Nov 17;9(22):e017624. doi: 10.1161/JAHA.120.017624. Epub 2020 Nov 3.
Background The clinical significance of conduction disturbances after transcatheter aortic valve implantation has been described; however, little is known about the influence of baseline ECGs in the prognosis of these patients. Our aim was to study the influence of baseline ECG parameters, including interatrial block (IAB), in the prognosis of patients treated with transcatheter aortic valve implantation. Methods and Results The BIT (Baseline Interatrial Block and Transcatheter Aortic Valve Implantation) registry included 2527 patients with aortic stenosis treated with transcatheter aortic valve implantation. A centralized analysis of baseline ECGs was performed. Patients were divided into 4 groups: normal P wave duration (<120 ms); partial IAB (P wave duration ≥120 ms, positive in the inferior leads); advanced IAB (P wave duration ≥120 ms, biphasic [+/-] morphology in the inferior leads); and nonsinus rhythm (atrial fibrillation/flutter and paced rhythm). The mean age of patients was 82.6±9.8 years and 1397 (55.3%) were women. A total of 960 patients (38.0%) had a normal P wave, 582 (23.0%) had partial IAB, 300 (11.9%) had advanced IAB, and 685 (27.1%) presented with nonsinus rhythm. Mean follow-up duration was 465±171 days. Advanced IAB was the only independent predictor of all-cause mortality (hazard ratio [HR], 1.48; 95% CI, 1.10-1.98 [=0.010]) and of the composite end point (death/stroke/new atrial fibrillation) (HR, 1.51; 95% CI, 1.17-1.94 [=0.001]). Conclusions Baseline ECG characteristics influence the prognosis of patients with aortic stenosis treated with transcatheter aortic valve implantation. Advanced IAB is present in about an eighth of patients and is associated with all-cause death and the composite end point of death, stroke, and new atrial fibrillation during follow-up.
经导管主动脉瓣植入术后传导障碍的临床意义已被描述；然而，对于基线心电图在这些患者预后中的影响知之甚少。我们的目的是研究基线心电图参数（包括房间隔阻滞（IAB））对经导管主动脉瓣植入治疗患者预后的影响。
BIT（基线房间隔阻滞和经导管主动脉瓣植入）登记研究纳入了 2527 例接受经导管主动脉瓣植入治疗的主动脉瓣狭窄患者。对基线心电图进行集中分析。患者分为 4 组：正常 P 波时限（<120ms）；部分 IAB（P 波时限≥120ms，下壁导联呈阳性）；高级 IAB（P 波时限≥120ms，下壁导联呈双相[+/-]形态）；和非窦性节律（心房颤动/扑动和起搏节律）。患者的平均年龄为 82.6±9.8 岁，1397 例（55.3%）为女性。共有 960 例（38.0%）患者的 P 波正常，582 例（23.0%）有部分 IAB，300 例（11.9%）有高级 IAB，685 例（27.1%）呈现非窦性节律。平均随访时间为 465±171 天。高级 IAB 是全因死亡率（危险比[HR]，1.48；95%可信区间，1.10-1.98[=0.010]）和复合终点（死亡/卒中/新发心房颤动）（HR，1.51；95%可信区间，1.17-1.94[=0.001]）的唯一独立预测因素。
基线心电图特征影响经导管主动脉瓣植入治疗的主动脉瓣狭窄患者的预后。约有八分之一的患者存在高级 IAB，与全因死亡以及随访期间死亡、卒中、新发心房颤动的复合终点相关。
