Department of Medicine Mayo Clinic Rochester MN.
Department of Cardiovascular Medicine Mayo Clinic Rochester MN.
J Am Heart Assoc. 2021 May 18;10(10):e020033. doi: 10.1161/JAHA.120.020033. Epub 2021 May 7.
Background The temporal incidence of high-grade atrioventricular block (HAVB) after transcatheter aortic valve replacement (TAVR) is uncertain. As a result, periprocedural monitoring and pacing strategies remain controversial. This study aimed to describe the temporal incidence of initial episode of HAVB stratified by pre- and post-TAVR conduction and identify predictors of delayed events. Methods and Results Consecutive patients undergoing TAVR at a single center between February 2012 and June 2019 were retrospectively assessed for HAVB within 30 days. Patients with prior aortic valve replacement, permanent pacemaker (PPM), or conversion to surgical replacement were excluded. Multivariable logistic regression was performed to assess predictors of delayed HAVB (initial event >24 hours post-TAVR). A total of 953 patients were included in this study. HAVB occurred in 153 (16.1%). After exclusion of those with prophylactic PPM placed post-TAVR, the incidence of delayed HAVB was 33/882 (3.7%). Variables independently associated with delayed HAVB included baseline first-degree atrioventricular block or right bundle-branch block, self-expanding valve, and new left bundle-branch block. Forty patients had intraprocedural transient HAVB, including 16 who developed HAVB recurrence and 6 who had PPM implantation without recurrence. PPM was placed for HAVB in 130 (13.6%) (self-expanding valve, 23.7% versus balloon-expandable valve, 11.9%; <0.001). Eight (0.8%) patients died by 30 days, including 1 unexplained without PPM present. Conclusions Delayed HAVB occurs with higher frequency in patients with baseline first-degree atrioventricular block or right bundle-branch block, new left bundle-branch block, and self-expanding valve. These findings provide insight into optimal monitoring and pacing strategies based on periprocedural ECG findings.
经导管主动脉瓣置换术(TAVR)后发生高度房室传导阻滞(HAVB)的时间发生率尚不确定。因此,围手术期监测和起搏策略仍存在争议。本研究旨在描述 TAVR 前后传导分层的初始 HAVB 时间发生率,并确定延迟事件的预测因素。
回顾性评估 2012 年 2 月至 2019 年 6 月期间在单一中心接受 TAVR 的连续患者在 30 天内发生 HAVB 的情况。排除既往主动脉瓣置换、永久性起搏器(PPM)或转为外科置换的患者。采用多变量逻辑回归评估延迟性 HAVB(初始事件发生在 TAVR 后 24 小时以上)的预测因素。共有 953 例患者纳入本研究。发生 HAVB 153 例(16.1%)。在排除 TAVR 后预防性放置 PPM 的患者后,延迟性 HAVB 的发生率为 33/882(3.7%)。与延迟性 HAVB 相关的独立变量包括基线一度房室传导阻滞或右束支传导阻滞、自膨式瓣膜和新的左束支传导阻滞。40 例患者术中发生短暂性 HAVB,其中 16 例出现 HAVB 复发,6 例出现 HAVB 复发但未复发 PPM。130 例(13.6%)因 HAVB 植入 PPM(自膨式瓣膜 23.7%比球囊扩张瓣膜 11.9%;<0.001)。8 例(0.8%)患者在 30 天内死亡,其中 1 例无 PPM 原因不明。
基线一度房室传导阻滞或右束支传导阻滞、新的左束支传导阻滞和自膨式瓣膜的患者发生延迟性 HAVB 的频率更高。这些发现为基于围手术期心电图结果的最佳监测和起搏策略提供了依据。