Abdulsalam Nashwa M, Poole Jeanne E, Lyden Elizabeth R, Easley Arthur J, Pavlides Gregory S, Tsai Shane F, Barton David E
Division of Cardiology, University of Washington, 1959 NE Pacific street, Seattle, WA, 98195, USA.
Division of Cardiology, University of Nebraska, Omaha, NE, USA.
J Interv Card Electrophysiol. 2022 Dec;65(3):765-772. doi: 10.1007/s10840-022-01361-3. Epub 2022 Sep 2.
The development of new left bundle branch block (LBBB) is frequently seen post TAVR and is a known risk factor for progression to high degree AV block. The timing and likelihood of progression into complete heart block is variable and can develop after hospital discharge. We sought to determine predictors for the development of high degree AV block in patients who developed LBBB following TAVR.
All patients between 2014 and 2019 underwent electrophysiology study after developing LBBB post TAVR. Data on these patients including baseline characteristics, echo parameters, EKG variables, HV interval, and the need for subsequent pacemaker implantation were extracted. A prolonged HV interval was defined as ≥ 65 ms. Clinically significant conduction abnormality was defined as development of high-degree AV block or clinically significant complete heart block.
Thirty-four patients were included in our study of which 10 (29.4%) developed clinically significant heart block, while 24 (70.6%) did not. The mean HV interval for patients with clinically significant heart block was 70.1 ms vs 57.8 ms for those who did not (p = 0.022). Pre-existing first-degree heart block prior to TAVR (p = 0.026), history of AFib (p = 0.05) in addition to STS score (p = 0.037) were predictors of development of high-degree AV block in our patient population.
In patients who develop LBBB following TAVR, HV interval, pre-existing first-degree heart block, and STS score predict progression to high-degree AV block. Performance of a routine electrophysiology study should be considered for high-risk patients who develop LBBB following TAVR.
经导管主动脉瓣置换术（TAVR）后新发左束支传导阻滞（LBBB）很常见，并且是进展为高度房室传导阻滞的已知危险因素。进展为完全性心脏传导阻滞的时间和可能性各不相同，且可能在出院后发生。我们试图确定TAVR后发生LBBB的患者发生高度房室传导阻滞的预测因素。
2014年至2019年间，所有患者在TAVR后发生LBBB后均接受了电生理检查。提取了这些患者的基线特征、超声心动图参数、心电图变量、HV间期以及后续起搏器植入需求等数据。HV间期延长定义为≥65毫秒。具有临床意义的传导异常定义为发生高度房室传导阻滞或具有临床意义的完全性心脏传导阻滞。
我们的研究纳入了34例患者，其中10例（29.4%）发生了具有临床意义的心脏传导阻滞，而24例（70.6%）未发生。发生具有临床意义的心脏传导阻滞的患者平均HV间期为70.1毫秒，未发生的患者为57.8毫秒（p = 0.022）。TAVR前存在一度心脏传导阻滞（p = 0.026）、房颤病史（p = 0.05）以及胸外科医师协会（STS）评分（p = 0.037）是我们研究人群中发生高度房室传导阻滞的预测因素。
在TAVR后发生LBBB的患者中，HV间期、既往一度心脏传导阻滞和STS评分可预测进展为高度房室传导阻滞。对于TAVR后发生LBBB的高危患者，应考虑进行常规电生理检查。
