Department of Internal Medicine, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA; Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
JACC Cardiovasc Interv. 2021 Jan 25;14(2):115-134. doi: 10.1016/j.jcin.2020.09.063.
Transcatheter aortic valve replacement (TAVR) is a safe and feasible alternative to surgery in patients with symptomatic severe aortic stenosis regardless of the surgical risk. Conduction abnormalities requiring permanent pacemaker (PPM) implantation remain a common finding after TAVR due to the close proximity of the atrioventricular conduction system to the aortic root. High-grade atrioventricular block and new onset left bundle branch block (LBBB) are the most commonly reported conduction abnormalities after TAVR. The overall rate of PPM implantation after TAVR varies and is related to pre-procedural and intraprocedural factors. The available literature regarding the impact of conduction abnormalities and PPM requirement on morbidity and mortality is still conflicting. Pre-procedural conduction abnormalities such as right bundle branch block and LBBB have been linked with increased PPM implantation and mortality after TAVR. When screening patients for TAVR, heart teams should be aware of various anatomical and pathophysiological conditions that make patients more susceptible to increased risk of conduction abnormalities and PPM requirement after the procedure. This is particularly important as TAVR has been recently approved for patients with low surgical risk. The purpose of this review is to discuss the incidence, predictors, impact, and management of the various conduction abnormalities requiring PPM implantation in patients undergoing TAVR.
经导管主动脉瓣置换术（TAVR）是一种安全可行的替代手术方法，适用于有症状的严重主动脉瓣狭窄患者，无论手术风险如何。由于房室传导系统与主动脉根部相邻，TAVR 后常出现需要永久性起搏器（PPM）植入的传导异常。高度房室传导阻滞和新发左束支传导阻滞（LBBB）是 TAVR 后最常报告的传导异常。TAVR 后 PPM 植入的总体发生率不同，与术前和术中因素有关。关于传导异常和 PPM 需求对发病率和死亡率的影响的相关文献仍然存在争议。术前传导异常，如右束支传导阻滞和 LBBB，与 TAVR 后 PPM 植入和死亡率增加有关。在为 TAVR 筛选患者时，心脏团队应该意识到各种解剖和病理生理状况会使患者更容易在手术后出现传导异常和 PPM 需求增加的风险。这一点尤为重要，因为 TAVR 最近已被批准用于低手术风险的患者。本综述的目的是讨论在接受 TAVR 的患者中需要 PPM 植入的各种传导异常的发生率、预测因素、影响和管理。
