Nauchi Masahiro, Yamawaki Masahiro, Nakano Takahide, Makino Kenji, Honda Yosuke, Sakai Tsuyoshi, Ito Yoshiaki
Cardiovascular Center, Saiseikai Yokohamashi Tobu Hospital.
Department of Cardiology, Heisei Yokohama Hospital.
Int Heart J. 2021 Sep 30;62(5):1012-1018. doi: 10.1536/ihj.21-145. Epub 2021 Sep 17.
High-degree atrioventricular block (HAVB) or complete heart block (CHB) is a common complication associated with transcatheter aortic valve replacement (TAVR). However, some patients with HAVB/CHB recover with time. The results of electrophysiological studies (EPSs) using permanent pacemaker implantation (PPI) in patients with suspicious HAVB/CHB are considered controversial.This study aimed to evaluate whether HAVB/CHB induction at the bedside using a temporary pacemaker can predict recurrence in patients who had recovered from HAVB/CHB after TAVR.We enrolled a total of 11 patients who had recovered from HAVB/CHB and evaluated their electrophysiology using right ventricular pacing and/or procainamide administration.HAVB/CHB induction was positive. Three patients tested positive for HAVB/CHB, whereas 8 tested negative. The ejection fraction and the interval between HAVB/CHB onset and EPS were found to be significant. HAVB/CHB positive patients underwent PPI. A patient with a balloon-expandable valve tested positive just before recovery of CHB, but tested negative 5 days later and was included in the negative group. The 4 patients who tested negative received a cardiovascular implantable electric device (CIED). We observed HAVB/CHB in 2 patients who had previously tested positive after 3 months. Among those who tested negative, those with CIED had no HAVB/CHB, and others showed neither HAVB/CHB on electrocardiogram nor experienced syncope or sudden death.Our EPS revealed that HAVB/CHB induction may predict HAVB/CHB recurrence after TAVR. Valve type and EPS timing may affect the results.
高度房室传导阻滞(HAVB)或完全性心脏传导阻滞(CHB)是经导管主动脉瓣置换术(TAVR)的常见并发症。然而,一些HAVB/CHB患者会随着时间推移而恢复。对于疑似HAVB/CHB患者使用永久性起搏器植入(PPI)进行电生理研究(EPS的结果存在争议。本研究旨在评估在床边使用临时起搏器诱发HAVB/CHB是否可预测TAVR术后HAVB/CHB已恢复患者的复发情况。我们共纳入了11例从HAVB/CHB中恢复的患者,并通过右心室起搏和/或普鲁卡因胺给药评估其电生理情况。HAVB/CHB诱发试验结果为阳性。3例患者HAVB/CHB诱发试验呈阳性,而8例呈阴性。结果发现射血分数以及HAVB/CHB发作与电生理研究之间的间隔时间具有显著意义。HAVB/CHB阳性患者接受了PPI。一名使用球囊扩张瓣膜的患者在CHB恢复前刚检测为阳性,但5天后检测为阴性,被纳入阴性组。4例检测为阴性的患者接受了心血管植入式电子装置(CIED)。我们观察到3个月后,2例先前检测为阳性的患者出现了HAVB/CHB。在检测为阴性的患者中,植入CIED的患者未出现HAVB/CHB,其他患者心电图上既未出现HAVB/CHB,也未发生晕厥或猝死。我们的电生理研究表明,HAVB/CHB诱发试验可能预测TAVR术后HAVB/CHB的复发。瓣膜类型和电生理研究时间可能会影响结果。