Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Italy.
Circ Arrhythm Electrophysiol. 2021 Jan;14(1):e009028. doi: 10.1161/CIRCEP.120.009028. Epub 2020 Dec 11.
Conduction disturbances after transcatheter aortic valve replacement (TAVR) are often transient. Limited data exist on anatomic factors predisposing to pacemaker dependency after TAVR. We sought to assess the rate and the possible predictors of pacemaker dependency after TAVR.
Consecutive patients undergoing pacemaker implantation up to 30 days after TAVR between May 2014 and September 2019 were included. Baseline electrocardiographic, computed tomography, and procedural characteristics were collected, including valve implantation depth and membranous septum length, an anatomic surrogate of the distance between the aortic annulus and the His bundle. Pacemaker dependency at 30 days and 1 year and all-cause mortality during follow-up were evaluated.
Of 728 TAVR patients, 112 (53.5% men; median age, 81 years) underwent pacemaker implantation after TAVR. Of these, 44.6% (50 of 112) were pacemaker dependent at 30 days and 46.7% (36 of 77) at 1 year. By multivariate analysis, independent predictors of 30-day pacemaker dependency included left ventricular outflow tract calcifications under the left coronary cusp (odds ratio, 5.69 [95% CI, 1.45-22.31]; =0.013) and a difference between membranous septum length and implantation depth (ΔMSID) ≥3 mm (odds ratio, 7.58 [95% CI, 2.07-27.78]; =0.002). Conversely, membranous septum length and implantation depth alone were not associated with pacemaker dependency (odds ratio, 0.79 [95% CI, 0.60-1.05]; =0.11 and odds ratio, 1.11 [95% CI, 0.99-1.24]; =0.08). At a median follow-up of 28.1 (11.7-48.6) months, pacemaker-dependent patients did not show a worse survival (=0.26).
Less than half of the patients undergoing pacemaker implantation after TAVR are pacemaker-dependent at midterm follow-up. ΔMSID ≥3 mm and the presence of left ventricular outflow tract calcifications under the left coronary cusp, but not membranous septum length nor implantation depth alone, are predictive of long-term pacemaker dependency after TAVR, thus influencing device selection and programming.
经导管主动脉瓣置换术（TAVR）后发生传导障碍通常是短暂的。关于 TAVR 后导致起搏器依赖的解剖学因素的数据有限。我们旨在评估 TAVR 后起搏器依赖的发生率和可能的预测因素。
连续纳入 2014 年 5 月至 2019 年 9 月期间 TAVR 后 30 天内植入起搏器的患者。收集基线心电图、计算机断层扫描和手术特征，包括瓣膜植入深度和室间隔膜部长度，这是主动脉瓣环和希氏束之间距离的解剖替代物。评估 30 天和 1 年时的起搏器依赖情况以及随访期间的全因死亡率。
在 728 例 TAVR 患者中，有 112 例（53.5%为男性；中位年龄 81 岁）在 TAVR 后植入了起搏器。其中，44.6%（50/112）在 30 天时需要起搏器依赖，46.7%（36/77）在 1 年时需要起搏器依赖。多变量分析显示，30 天内起搏器依赖的独立预测因素包括左冠状动脉瓣下左心室流出道钙化（比值比，5.69[95%CI，1.45-22.31]；=0.013）和室间隔膜部长度与植入深度差值（ΔMSID）≥3mm（比值比，7.58[95%CI，2.07-27.78]；=0.002）。相反，单独的室间隔膜部长度和植入深度与起搏器依赖无关（比值比，0.79[95%CI，0.60-1.05]；=0.11 和比值比，1.11[95%CI，0.99-1.24]；=0.08）。中位随访 28.1（11.7-48.6）个月时，起搏器依赖患者的生存情况并未恶化（=0.26）。
TAVR 后植入起搏器的患者中，不到一半在中期随访时需要起搏器依赖。ΔMSID≥3mm 和左冠状动脉瓣下左心室流出道钙化的存在，但不是室间隔膜部长度或单独的植入深度，可预测 TAVR 后长期起搏器依赖，从而影响设备选择和编程。
