Baraka Mahmoud, Kamal Diaa, Mostafa Ahmad E
Department of Cardiology, Ain Shams University, Cairo, Egypt.
Department of Cardiology, Ain Shams University, Cairo, Egypt.
Indian Pacing Electrophysiol J. 2024 May-Jun;24(3):133-139. doi: 10.1016/j.ipej.2024.03.003. Epub 2024 Mar 26.
Conduction disturbances remain one of the most common complications occurring post TAVI. We aim to determine the predictors of cardiac conduction disturbances after Transcatheter Aortic Valve Implantation (TAVI) and propose a relevant predictive model. We included 70 consecutive patients with severe symptomatic AS who underwent TAVI using the self-expanding valve Evolut R or the balloon expandable Sapien XT valve. All patients were subjected to electrocardiographic evaluation pre- and post-TAVI and at 30 days. Clinical, echocardiographic, CT-derived, and procedural parameters were collected and analyzed.
Conduction disturbances affected 28 patients (40%): 16 patients (22.9 %) developed Left Bundle Branch Block (LBBB), 7 patients (10%) experienced transient Complete Heart Block (CHB), and 5 patients (7.1%) experienced permanent CHB requiring Permanent Pacemaker Implantation (PPI). We classified predictors into preprocedural and procedural predictors. Multivariate logistic regression analysis of pre-procedural predictors showed that the presence of basal septal calcification is the most powerful independent predictor (OR: 28.63, 95% CI: 4.59-178.68, p < 0.001). Multivariate logistic regression analysis for pre and post procedural predictors showed that the relationship between depth of implantation at the septum and membranous septum expressed in percentage (sDIMS) with cut-off >70.42% is the most powerful independent procedural predictor (OR: 1.11, 95% CI: 1.03-1.2, p 0.006).
Conduction disturbances remain a common complication of TAVI. Presence of basal septal calcification is a non-modifiable risk factor that increase patient propensity of development such complication after TAVI. A depth of implantation exceeding 70% of the membranous septal length has been found to strongly predict conduction disturbances post TAVI. sDIMS can be used in planning the depth of implantation to reduce incidence of conduction disturbances post TAVI.
传导障碍仍然是经导管主动脉瓣植入术（TAVI）后最常见的并发症之一。我们旨在确定经导管主动脉瓣植入术后心脏传导障碍的预测因素，并提出一个相关的预测模型。我们纳入了70例连续的严重症状性主动脉瓣狭窄患者，他们接受了使用自膨胀式Evolut R瓣膜或球囊扩张式Sapien XT瓣膜的TAVI治疗。所有患者在TAVI术前、术后及术后30天均接受心电图评估。收集并分析了临床、超声心动图、CT衍生及手术参数。
传导障碍影响了28例患者（40%）：16例患者（22.9%）发生左束支传导阻滞（LBBB），7例患者（10%）经历短暂性完全性心脏传导阻滞（CHB），5例患者（7.1%）经历永久性CHB并需要植入永久性起搏器（PPI）。我们将预测因素分为术前和术中预测因素。术前预测因素的多因素逻辑回归分析显示，基底间隔钙化的存在是最有力的独立预测因素（比值比：28.63，95%置信区间：4.59 - 178.68，p < 0.001）。术前和术中预测因素的多因素逻辑回归分析显示，以百分比表示的间隔和膜性间隔植入深度之间的关系（sDIMS），截断值>70.42%是最有力的独立术中预测因素（比值比：1.11，95%置信区间：1.03 - 1.2，p = 0.006）。
传导障碍仍然是TAVI的常见并发症。基底间隔钙化的存在是一个不可改变的危险因素，会增加患者TAVI术后发生此类并发症的倾向。已发现植入深度超过膜性间隔长度的70%可强烈预测TAVI术后的传导障碍。sDIMS可用于规划植入深度，以降低TAVI术后传导障碍的发生率。
