Université de Rennes 1, CHU Rennes Service de Cardiologie, Inserm LTSI U1099, Rennes, France.
Université de Rennes 1, CHU Rennes Service de Chirurgie Cardiaque, Inserm LTSI U1099, Rennes, France.
Heart Rhythm. 2022 Jul;19(7):1124-1132. doi: 10.1016/j.hrthm.2022.03.002. Epub 2022 Mar 4.
Conduction disturbances requiring permanent pacemaker implantation (PPI) remain a common complication of transcatheter aortic valve replacement (TAVR).
The purpose of this study was to determine the prognostic impact of PPI after TAVR according to the timing of implantation relative to TAVR.
A total of 1199 patients (median age 83 years; interquartile range 78-86 years; 549 [45.8%] female) were included in the analysis, of whom 894 (70.8%) had not undergone PPI, 130 (10.8%) had undergone previous PPI, 116 (9.7%) had undergone in-hospital PPI, and 59 (4.9%) had undergone PPI during follow-up. Median follow-up was 2.94 years (1.42-4.32 years). The primary outcome was the composite of all-cause mortality and hospitalization for heart failure.
PPI during follow-up was associated with a higher occurrence of the primary outcome (hazard ratio [HR] 2.11; 95% confidence interval [CI] 1.39-3.20) whereas previous PPI and in-hospital PPI were not (HR 0.96; 95% CI 0.71-1.29 and HR 1.26; 95% CI 0.88-1.81, respectively). PPI during follow-up was associated with a higher risk of hospitalization for heart failure (sub-HR 3.21; 95% CI 2.02-5.11), while this relationship was only borderline significant for previous PPI (sub-HR 1.51; 95% CI 0.99-2.29). In contrast, there was no relationship between in-hospital PPI and the subsequent risk of hospitalization for heart failure.
Previous PPI and in-hospital PPI had no long-term prognostic impact on the risk of all-cause mortality and hospitalization for heart failure, whereas PPI during follow-up was associated with a higher risk of hospitalization for heart failure. The present study questions the deleterious influence of periprocedural post-TAVR PPI, which has previously been suggested by certain studies.
需要永久性心脏起搏器植入（PPI）的传导障碍仍然是经导管主动脉瓣置换术（TAVR）的常见并发症。
本研究旨在根据 TAVR 后 PPI 植入的时间，确定 TAVR 后 PPI 对预后的影响。
共纳入 1199 例患者（中位年龄 83 岁；四分位距 78-86 岁；549[45.8%]例女性），其中 894 例（70.8%）未行 PPI，130 例（10.8%）行过 PPI，116 例（9.7%）行院内 PPI，59 例（4.9%）在随访期间行 PPI。中位随访时间为 2.94 年（1.42-4.32 年）。主要终点是全因死亡率和心力衰竭住院的复合终点。
随访期间行 PPI 与主要终点发生率较高相关（风险比[HR]2.11；95%置信区间[CI]1.39-3.20），而既往 PPI 和院内 PPI 则无相关性（HR0.96；95%CI0.71-1.29 和 HR1.26；95%CI0.88-1.81）。随访期间行 PPI 与心力衰竭住院风险增加相关（亚 HR3.21；95%CI2.02-5.11），而既往 PPI 与心力衰竭住院风险增加仅呈边缘显著相关（亚 HR1.51；95%CI0.99-2.29）。相反，院内 PPI 与心力衰竭住院的后续风险之间没有关系。
既往 PPI 和院内 PPI 对全因死亡率和心力衰竭住院的风险无长期预后影响，而随访期间行 PPI 与心力衰竭住院风险增加相关。本研究对某些研究先前提出的围手术期 post-TAVR PPI 的有害影响提出质疑。
