Papa Andrea, Serban Teodor, Strebel Ivo, Knecht Sven, Isenegger Corinne, Nestelberger Thomas, Kaiser Christoph, Leibundgut Gregor, Haaf Philipp, Schaer Beat, Krisai Philipp, Osswald Stefan, Sticherling Christian, Kühne Michael, Badertscher Patrick
Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland.
Heart Rhythm O2. 2023 Dec 18;5(2):113-121. doi: 10.1016/j.hroo.2023.12.003. eCollection 2024 Feb.
Infranodal conduction disorders are common after transcatheter aortic valve replacement (TAVR). Risk factors are incompletely understood.
The purpose of this study was to assess the impact of valve implantation depth and calcium burden of the device landing zone on infranodal conduction intraprocedure pre- and post-TAVR.
In all patients undergoing TAVR between June 2020 and June 2021, the His-ventricle (HV) interval was measured pre- and post-valve deployment. The difference between the 2 measurements defined delta HV, whereas infranodal conduction delay was defined as HV interval >55 ms. Valve implantation depth was measured as the distance between the aortic annular plane and the ventricular prosthesis end. Calcium burden was quantified as the volume of calcium in 6 regions of interest: the non-, right, and left coronary cusps (NCC, RCC, and LCC, respectively) and the corresponding regions of the left ventricular outflow tract (LVOT) underlying each cusp (LVOT, LVOT, LVOT, respectively).
Of 101 patients (mean age 81 ± 5.7 years; 47% women), 37 demonstrated infranodal conduction delay intraprocedure post-TAVR. Overall, mean implantation depth was 5 ± 3.1 mm, median calcium volume was 2080 mm [interquartile range 632-2400]. Delta HV showed no correlation with implantation depth or calcium burden (r = -0.08 and r = 0.12, respectively). However, LVOT calcification was a significant predictor for infranodal conduction delay post-valve deployment in a multivariable logistic regression model (odds ratio 1.62 per 100-mm increase (95% confidence interval 1.06-2.69; = .04).
Assessment of LVOT calcification may identify patients at risk for infranodal conduction delay after TAVR, whereas implantation depth did not predict infranodal conduction delay.
经导管主动脉瓣置换术（TAVR）后结下传导障碍很常见。危险因素尚未完全明确。
本研究旨在评估瓣膜植入深度和装置着陆区的钙化负荷对TAVR术中及术后结下传导的影响。
在2020年6月至2021年6月期间接受TAVR的所有患者中，在瓣膜展开前后测量希氏束-心室（HV）间期。两次测量的差值定义为HV变化量（delta HV），而结下传导延迟定义为HV间期>55毫秒。瓣膜植入深度测量为主动脉瓣环平面与心室假体末端之间的距离。钙化负荷通过6个感兴趣区域的钙体积进行量化：无冠瓣、右冠瓣和左冠瓣（分别为NCC、RCC和LCC）以及每个瓣叶下方左心室流出道（LVOT）的相应区域（分别为LVOT、LVOT、LVOT）。
101例患者（平均年龄81±5.7岁；47%为女性）中，37例在TAVR术后术中出现结下传导延迟。总体而言，平均植入深度为5±3.1毫米，钙体积中位数为2080立方毫米[四分位间距632 - 2400]。Delta HV与植入深度或钙化负荷均无相关性（分别为r = -0.08和r = 0.12）。然而，在多变量逻辑回归模型中，LVOT钙化是瓣膜展开后结下传导延迟的显著预测因素（每增加100立方毫米，优势比为1.62（95%置信区间1.06 - 2.69；P = 0.04）。
评估LVOT钙化可能有助于识别TAVR术后有结下传导延迟风险的患者，而植入深度并不能预测结下传导延迟。
