Nozica Nikolas, Siontis George C M, Elchinova Elena Georgieva, Goulouti Eleni, Asami Masahiko, Bartkowiak Joanna, Baldinger Samuel, Servatius Helge, Seiler Jens, Tanner Hildegard, Noti Fabian, Haeberlin Andreas, Branca Mattia, Lanz Jonas, Stortecky Stefan, Pilgrim Thomas, Windecker Stephan, Reichlin Tobias, Praz Fabien, Roten Laurent
Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan.
Front Cardiovasc Med. 2022 May 16;9:876546. doi: 10.3389/fcvm.2022.876546. eCollection 2022.
Transcatheter aortic valve implantation (TAVI) is associated with new onset brady- and tachyarrhythmias which may impact clinical outcome.
To investigate the true incidence of new onset arrhythmias within 12 months after TAVI using an implantable cardiac monitor (ICM).
One hundred patients undergoing TAVI received an ICM within 3 months before or up to 5 days after TAVI. Patients were followed-up for 12 months after discharge from TAVI for the occurrence of atrial fibrillation (AF), bradycardia (≤30 bpm), advanced atrioventricular (AV) block, sustained ventricular and supraventricular tachycardia.
A previously undiagnosed arrhythmia was observed in 31 patients (31%) and comprised AF in 19 patients (19%), advanced AV block in 3 patients (3%), and sustained supraventricular and ventricular tachycardia in 10 (10%) and 2 patients (2%), respectively. Three patients had a clinical diagnosis of sick-sinus-syndrome. A permanent pacemaker (PPM) was implanted in six patients (6%). The prevalence of pre-existing AF was 28%, and 47% of the patients had AF at the end of the study period. AF burden was significantly higher in patients with pre-existing [26.7% (IQR 0.3%; 100%)] compared to patients with new-onset AF [0.0% (IQR 0.0%; 0.06%); = 0.001]. Three patients died after TAVI without evidence of an arrhythmic cause according to the available ICM recordings.
Rhythm monitoring for 12 months after TAVI revealed new arrhythmias, mainly AF, in almost one third of patients. Atrial fibrillation burden was higher in patients with prevalent compared to incident AF. Selected patients may benefit from short-term remote monitoring.
https://clinicaltrials.gov/: NCT02559011.
经导管主动脉瓣植入术（TAVI）与新发缓慢性和快速性心律失常相关，这可能会影响临床结局。
使用植入式心脏监测器（ICM）调查TAVI术后12个月内新发心律失常的真实发生率。
100例行TAVI的患者在TAVI术前3个月内或术后5天内植入ICM。TAVI出院后对患者随访12个月，观察房颤（AF）、心动过缓（≤30次/分钟）、高度房室（AV）传导阻滞、持续性室性和室上性心动过速的发生情况。
31例患者（31%）观察到既往未诊断的心律失常，其中19例（19%）为房颤，3例（3%）为高度AV传导阻滞，10例（10%）为持续性室上性心动过速，2例（2%）为持续性室性心动过速。3例患者临床诊断为病态窦房结综合征。6例患者（6%）植入了永久性起搏器（PPM）。既往房颤的患病率为28%，47%的患者在研究期末发生房颤。与新发房颤患者相比，既往有房颤患者的房颤负荷显著更高[26.7%（IQR 0.3%；100%）]，新发房颤患者为[0.0%（IQR 0.0%；0.06%）]；P = 0.001。根据可用的ICM记录，3例患者TAVI术后死亡，无心律失常原因的证据。
TAVI术后12个月的心律监测发现近三分之一的患者出现新发心律失常，主要为房颤。与新发房颤患者相比，既往有房颤患者的房颤负荷更高。部分患者可能从短期远程监测中获益。
