Cardiology Department, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
Department of Surgery, Division of Cardiac Surgery, Robert Wood Johnson University Medical School, New Brunswick, New Jersey, USA.
JACC Cardiovasc Interv. 2021 Dec 27;14(24):2711-2722. doi: 10.1016/j.jcin.2021.08.039.
The aim of this study was to determine the impact of delayed high-degree atrioventricular block (HAVB) or complete heart block (CHB) after transcatheter aortic valve replacement (TAVR) using a minimalist approach followed by ambulatory electrocardiographic (AECG) monitoring.
Little is known regarding the clinical impact of HAVB or CHB in the early period after discharge following TAVR.
A prospective, multicenter study was conducted, including 459 consecutive TAVR patients without permanent pacemaker who underwent continuous AECG monitoring for 14 days (median length of hospital stay 2 days; IQR: 1-3 days), using 2 devices (CardioSTAT and Zio AT). The primary endpoint was the occurrence of HAVB or CHB. Patients were divided into 3 groups: 1) no right bundle branch block (RBBB) and no electrocardiographic (ECG) changes; 2) baseline RBBB with no further changes; and 3) new-onset ECG conduction disturbances.
Delayed HAVB or CHB episodes occurred in 21 patients (4.6%) (median 5 days postprocedure; IQR: 4-6 days), leading to PPM in 17 (81.0%). HAVB or CHB events were rare in group 1 (7 of 315 [2.2%]), and the incidence increased in group 2 (5 of 38 [13.2%]; P < 0.001 vs group 1) and group 3 (9 of 106 [8.5%]; P = 0.007 vs group 1; P = 0.523 vs group 2). No episodes of sudden or all-cause death occurred at 30-day follow-up.
Systematic 2-week AECG monitoring following minimalist TAVR detected HAVB and CHB episodes in about 5% of cases, with no mortality at 1 month. Whereas HAVB or CHB was rare in patients without ECG changes post-TAVR, baseline RBBB and new-onset conduction disturbances determined an increased risk. These results would support tailored management using AECG monitoring and the possibility of longer hospitalization periods in patients at higher risk for delayed HAVB or CHB.
本研究旨在通过使用微创方法和门诊心电图（AECG）监测，确定经导管主动脉瓣置换（TAVR）后延迟出现高度房室传导阻滞（HAVB）或完全心脏阻滞（CHB）的影响。
关于 TAVR 后早期出院后 HAVB 或 CHB 的临床影响知之甚少。
进行了一项前瞻性、多中心研究，纳入了 459 例连续 TAVR 患者，这些患者在植入永久性起搏器前，接受了为期 14 天的连续 AECG 监测（中位住院时间为 2 天；IQR：1-3 天），使用了 2 种设备（CardioSTAT 和 Zio AT）。主要终点是出现 HAVB 或 CHB。患者被分为 3 组：1）无右束支阻滞（RBBB）且无心电图（ECG）改变；2）基线 RBBB 且无进一步改变；3）新出现的心电图传导障碍。
21 例（4.6%）患者出现延迟性 HAVB 或 CHB 发作（中位数为术后 5 天；IQR：4-6 天），导致 17 例（81.0%）患者植入永久性起搏器。组 1（315 例中的 7 例，2.2%）中 HAVB 或 CHB 事件少见，而组 2（38 例中的 5 例，13.2%；P<0.001 比组 1）和组 3（106 例中的 9 例，8.5%；P=0.007 比组 1；P=0.523 比组 2）中则更为常见。在 30 天随访时，没有发生心源性猝死或全因死亡事件。
在微创 TAVR 后进行为期 2 周的系统 AECG 监测，在约 5%的病例中检测到 HAVB 和 CHB 发作，但在 1 个月时无死亡率。虽然 TAVR 后无心电图改变的患者中 HAVB 或 CHB 少见，但基线 RBBB 和新出现的传导障碍会增加风险。这些结果将支持使用 AECG 监测进行个体化管理，并为延迟性 HAVB 或 CHB 风险较高的患者提供更长的住院时间。
