Apiyasawat Sirin, Chandavimol Mann, Soontornmanokati Natcha, Sirikhamkorn Chulaporn
Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Division of Cardiology, Ramathibodi Hospital, Bangkok, Thailand.
Cardiovasc Diagn Ther. 2023 Aug 31;13(4):628-637. doi: 10.21037/cdt-23-63. Epub 2023 Jul 31.
Atrioventricular conduction disturbance occurs in a significant number of patients undergoing transcatheter aortic valve replacement (TAVR). However, not all cases are ventricular pacing-dependent. Thus, we aimed to study the incidence, predictors, and outcomes of new ventricular pacing dependency (VpDep) after TAVR.
We prospectively analyzed 130 consecutive transfemoral TAVR cases performed in Ramathibodi Hospital between 2015 and 2020. Three patients with prior ventricular pacing-dependent on cardiac implantable electronic devices (CIEDs) were excluded. The endpoints were VpDep at 1 month and all-cause mortality at the follow-up period end in 2021. The effects of variables on VpDep and all-cause mortality were evaluated using multivariate binary logistic regression and Cox regression analyses, respectively. First-degree atrioventricular block (AVB) was considered severe when the PR interval was >300 ms.
Of the 127 patients [mean age, 81.8 years; 62.2% females; 67.7% balloon-expandable (BE) device], 7 patients (5.5%) had CIEDs implanted before TAVR that were not ventricular pacing-dependent. TAVR was successfully performed in 126 (99.2%) patients. Periprocedural stroke, cardiac tamponade, and major bleeding occurred in 2 (1.6%), 4 (3.1%), and 4 (3.1%) patients, respectively. The VpDep incidence at 1 month was 7.9% (n=10) among all patients and 34.5% among those with CIEDs (n=29). VpDep was more likely to occur in patients with pre-existing right bundle branch block (RBBB) [odds ratio (OR), 21.38; 95% confidence interval (CI): 3.28-139.33; P=0.001] and severe 1 degree or Mobitz I AVB (OR, 14.79; 95% CI: 1.65-132.74; P=0.016). After a mean follow-up of 25.8 months [standard deviation (SD), 21.2 months], death from any cause occurred in 18 patients (14.2%). However, VpDep was not associated with an increased mortality.
In this real-world cohort, pre-existing conduction abnormalities were significantly associated with a higher risk of VpDep. Mortality was similar between patients with and without VpDep.
大量接受经导管主动脉瓣置换术（TAVR）的患者会出现房室传导障碍。然而，并非所有病例都依赖心室起搏。因此，我们旨在研究TAVR术后新出现的心室起搏依赖（VpDep）的发生率、预测因素及预后。
我们前瞻性分析了2015年至2020年在拉玛蒂博迪医院连续进行的130例经股动脉TAVR病例。排除3例先前依赖心脏植入式电子设备（CIED）进行心室起搏的患者。终点为1个月时的VpDep以及2021年随访期末的全因死亡率。分别使用多因素二元逻辑回归和Cox回归分析评估各变量对VpDep和全因死亡率的影响。当PR间期>300 ms时，一度房室传导阻滞（AVB）被视为严重。
127例患者[平均年龄81.8岁；62.2%为女性；67.7%使用球囊扩张式（BE）装置]中，7例（5.5%）在TAVR术前植入了非心室起搏依赖的CIED。126例（99.2%）患者TAVR手术成功。围手术期分别有2例（1.6%）、4例（3.1%）和4例（3.1%）患者发生卒中、心脏压塞和大出血。所有患者中1个月时VpDep的发生率为7.9%（n = 10），CIED患者中为34.5%（n = 29）。VpDep更易发生于既往有右束支传导阻滞（RBBB）的患者[比值比（OR），21.38；95%置信区间（CI）：3.28 - 139.33；P = 0.001]以及严重一度或莫氏I型AVB患者（OR，14.79；95%CI：1.65 - 132.74；P = 0.016）。平均随访25.8个月[标准差（SD），21.2个月]后，18例患者（14.2%）死于任何原因。然而，VpDep与死亡率增加无关。
在这个真实世界队列中，既往存在的传导异常与VpDep风险较高显著相关。有VpDep和无VpDep的患者死亡率相似。
