在经皮球囊扩张式 TAVR 前后行快速心房起搏对预测永久性起搏器植入的作用。
Utility of rapid atrial pacing before and after TAVR with balloon-expandable valve in predicting permanent pacemaker implantation.
机构信息
Department of Internal Medicine, Rochester General Hospital, Rochester, New York, USA.
Sands-Constellation Heart Institute, Rochester Regional Health, Rochester, New York, USA.
出版信息
Catheter Cardiovasc Interv. 2023 Nov;102(5):919-928. doi: 10.1002/ccd.30817. Epub 2023 Sep 12.
BACKGROUND
High-grade or complete atrioventricular block (AVB) requiring permanent pacemaker (PPM) implantation is a known complication of transcatheter aortic valve replacement (TAVR). Wenckebach AVB induced by rapid atrial pacing (RAP) after TAVR was previously demonstrated in an observational analysis to be an independent predictor for PPM. We sought to investigate the utility of both pre- and post-TAVR RAP in predicting PPM implantation.
METHODS
In a single-center, prospective study, 421 patients underwent TAVR with balloon-expandable valves (BEV) between April 2020 and August 2021. Intraprocedural RAP was performed in patients without a pre-existing pacemaker, atrial fibrillation/flutter, or intraprocedural complete AVB to assess for RAP-induced Wenckebach AVB. The primary outcome was PPM within 30 days after TAVR.
RESULTS
RAP was performed in 253 patients, of whom 91.3% underwent post-TAVR RAP and 61.2% underwent pre-TAVR RAP. The overall PPM implantation rate at 30 days was 9.9%. Although there was a numerically higher rate of PPM at 30 days in patients with RAP-induced Wenckebach AVB, it did not reach statistical significance (13.3% vs. 8.4%, p = 0.23). In a multivariable analysis, RAP-induced Wenckebach was not an independent predictor for PPM implantation at 30 days after TAVR. PPM rates at 30 days were comparable in patients with or without pre-TAVR pacing-induced Wenckebach AVB (11.8% vs. 8.2%, p = 0.51) and post-TAVR pacing-induced Wenckebach AVB (10.2% vs. 5.8%, p = 0.25).
CONCLUSION
In patients who underwent TAVR with BEV, there were no statistically significant differences in PPM implantation rates at 30 days regardless of the presence or absence of RAP-induced Wenckebach AVB. Due to conflicting results between the present study and the prior observational analysis, future studies with larger sample sizes are warranted to determine the role of RAP during TAVR as a risk-stratification tool for significant AVB requiring PPM after TAVR.
背景
经导管主动脉瓣置换术（TAVR）后发生需要永久性起搏器（PPM）植入的高级别或完全性房室传导阻滞（AVB）是已知的并发症。先前的观察性分析表明，TAVR 后快速心房起搏（RAP）引起的 Wenckebach AVB 是 PPM 的独立预测因素。我们试图研究 TAVR 前后 RAP 在预测 PPM 植入中的作用。
方法
在一项单中心前瞻性研究中，2020 年 4 月至 2021 年 8 月期间，421 例患者接受了球囊扩张瓣膜（BEV）TAVR。对无预先存在的起搏器、心房颤动/扑动或术中完全性 AVB 的患者进行术中 RAP，以评估 RAP 诱导的 Wenckebach AVB。主要结局是 TAVR 后 30 天内植入 PPM。
结果
对 253 例患者进行了 RAP，其中 91.3%进行了 TAVR 后 RAP，61.2%进行了 TAVR 前 RAP。30 天内总体 PPM 植入率为 9.9%。尽管 RAP 诱导的 Wenckebach AVB 患者 30 天内 PPM 植入率较高，但差异无统计学意义（13.3%比 8.4%，p=0.23）。多变量分析显示，RAP 诱导的 Wenckebach 不是 TAVR 后 30 天 PPM 植入的独立预测因素。TAVR 前 RAP 诱导的 Wenckebach AVB（11.8%比 8.2%，p=0.51）和 TAVR 后 RAP 诱导的 Wenckebach AVB（10.2%比 5.8%，p=0.25）患者 30 天内 PPM 植入率无统计学差异。
结论
在接受 BEV TAVR 的患者中，无论是否存在 RAP 诱导的 Wenckebach AVB，30 天内 PPM 植入率无统计学差异。由于本研究与之前的观察性分析结果存在矛盾，因此需要更大样本量的未来研究来确定 TAVR 期间 RAP 作为 TAVR 后需要 PPM 的显著 AVB 的风险分层工具的作用。
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