Department of Cardiology, Elazığ Fethi Sekin City Hospital, Elazığ, Turkiye.
Department of Cardiology, Faculty of Medicine, Erciyes University, Kayseri, Turkiye.
Turk J Med Sci. 2023 Oct 25;53(6):1799-1806. doi: 10.55730/1300-0144.5750. eCollection 2023.
BACKGROUND/AIM: Despite advancements in valve technology and increased clinical experience, complications related to conduction defects after transcatheter aortic valve implantation (TAVR) have not improved as rapidly as expected. In this study, we aimed to predict the development of complete atrioventricular (AV) block and bundle branch block during and after the TAVR procedure and to investigate any changes in the cardiac conduction system before and after the procedure using electrophysiological study.
A total of 30 patients who were scheduled for TAVR at our cardiovascular council were planned to be included in the study. TAVR was performed on patients at Erciyes University Medical Faculty Hospital as a single center between May 2019 and August 2020 Diagnostic electrophysiological study was performed before the TAVR procedure and after its completion. Changes in the cardiac conduction system during the preprocedure, intra-procedure, and postprocedure periods were recorded.
Significant increases in baseline cycle length, atrial-His (AH) interval, his-ventricular (HV) interval and atrioventricular (AV) distance were observed before and after the TAVR procedure (p = 0.039, p < 0.001, p = 0.018, p < 0.001, respectively). During the TAVR procedure, the preprocedural HV interval was longer in patients who developed AV block and bundle branch block compared to those who did not and this difference was statistically significant (p = 0.024). ROC curve analysis revealed that a TAVR preprocedure HV value >59.5 ms had 86% specificity and 75% sensitivity in detecting AV block and bundle branch block (AUC = 0.83, 95% CI: 0.664-0.996, p = 0.013). The preprocedure HV distance was 98 ± 10.55ms in the group with permanent pacemaker implantation and the mean value in the group without permanent pacemaker implantation was 66.27 ± 15.55 ms, showing a borderline significant difference (p = 0.049).
The prolongation of HV interval in patients with AV block and bundle branch block suggests that the block predominantly occurs at the infra-hisian level. Patients with longer preprocedural HV intervals should be closely monitored for the need for permanent pacemaker implantation after the TAVR procedure.
背景/目的：尽管瓣膜技术不断进步且临床经验日益丰富，但经导管主动脉瓣置换术（TAVR）后与传导缺陷相关的并发症并未如预期般迅速改善。本研究旨在通过电生理研究预测 TAVR 过程中和之后完全性房室（AV）阻滞和束支阻滞的发生，并探讨术前和术后心脏传导系统的任何变化。
计划纳入 30 名在我们心血管委员会接受 TAVR 的患者。2019 年 5 月至 2020 年 8 月在埃尔吉耶斯大学医学院附属医院作为单中心进行 TAVR。在 TAVR 术前和术后进行诊断性电生理研究。记录术前、术中、术后期间心脏传导系统的变化。
TAVR 术前和术后基础周期长度、房-希（AH）间期、希-室（HV）间期和房室（AV）距离均显著增加（p = 0.039，p < 0.001，p = 0.018，p < 0.001，分别）。在 TAVR 过程中，与未发生 AV 阻滞和束支阻滞的患者相比，发生 AV 阻滞和束支阻滞的患者术前 HV 间期较长，且差异具有统计学意义（p = 0.024）。ROC 曲线分析显示，TAVR 术前 HV 值>59.5 ms 对检测 AV 阻滞和束支阻滞具有 86%的特异性和 75%的敏感性（AUC = 0.83，95%CI：0.664-0.996，p = 0.013）。在需要植入永久性起搏器的患者中，术前 HV 距离为 98 ± 10.55ms，而在无需植入永久性起搏器的患者中，平均 HV 距离为 66.27 ± 15.55ms，差异具有边缘统计学意义（p = 0.049）。
AV 阻滞和束支阻滞患者 HV 间期延长提示阻滞主要发生在下希氏束水平。术前 HV 间期较长的患者应密切监测 TAVR 术后是否需要植入永久性起搏器。
