Alabdaljabar Mohamad S, Elhadi Mohamed, Gulati Rajiv, Rihal Charanjit S, Friedman Paul A, Cha Yong-Mei, Eleid Mackram F
Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota.
Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.
Struct Heart. 2024 May 22;8(4):100317. doi: 10.1016/j.shj.2024.100317. eCollection 2024 Jul.
Conduction disease is an important and common complication post-transcatheter aortic valve replacement (TAVR). Previously, we developed a conduction disease risk stratification and management protocol post-TAVR. This study aims to evaluate high-grade aortic valve block (HAVB) incidence and risk factors in a large cohort undergoing ambulatory cardiac monitoring post-TAVR according to conduction risk grouping.
This single-center, retrospective study evaluated all patients discharged on ambulatory cardiac monitoring between 2016 and 2021 and stratified them into 3 groups based on electrocardiogram predictors of HAVB risk (group 1 [low], group 2 [intermediate], and group 3 [high]). HAVB was defined as ≥2 consecutive nonconducted P waves in sinus rhythm or bradycardia <50 beats/minute with a fixed rate for atrial fibrillation/flutter. Descriptive statistics were used to show the incidence and timeline, while logistic regression was utilized to evaluate predictors of HAVB.
Five hundred twenty-eight patients were included (median age 80 years [74-85]; 43.8% female). Forty-one patients (7.8%) developed HAVB during ambulatory monitoring (68% were asymptomatic). Over a median follow-up of 2 years (1.3-2.7), the overall mortality rate was 15.0% (30-day mortality rate of 0.57%, n = 3). Risk factors for HAVB were male sex (odds ratio [OR] = 2.46, = 0.02, 95% CI = 1.21-5.43), baseline right bundle branch block (OR = 2.80, = 0.01, 95% CI = 1.17-6.19), and post-TAVR QRS >150 ms (OR = 2.16, = 0.03, 95% CI = 1.01-4.40). The negative predictive value for patients in groups 1 and 2 for 30-day HAVB was 95.0 and 93.8%, respectively.
The risk of 30-day HAVB post-TAVR on ambulatory monitoring post-TAVR varies according to post-TAVR electrocardiogram findings, and a 3-group algorithm effectively identifies groups with a low negative predictive value for HAVB.
传导疾病是经导管主动脉瓣置换术（TAVR）后一种重要且常见的并发症。此前，我们制定了TAVR后传导疾病风险分层及管理方案。本研究旨在根据传导风险分组，评估一大群接受TAVR后动态心脏监测患者的高度房室传导阻滞（HAVB）发生率及危险因素。
这项单中心回顾性研究评估了2016年至2021年间所有出院后接受动态心脏监测的患者，并根据HAVB风险的心电图预测指标将他们分为3组（1组[低风险]、2组[中风险]和3组[高风险]）。HAVB定义为窦性心律时连续≥2个未下传的P波，或房颤/房扑时心率固定且心动过缓<50次/分钟。采用描述性统计来显示发生率和时间线，同时利用逻辑回归评估HAVB的预测因素。
纳入528例患者（中位年龄80岁[74 - 85岁]；43.8%为女性）。41例患者（7.8%）在动态监测期间发生HAVB（68%无症状）。中位随访2年（1.3 - 2.7年），总死亡率为15.0%（30天死亡率为0.57%，n = 3）。HAVB的危险因素为男性（比值比[OR]=2.46，P = 0.02，95%置信区间[CI]=1.21 - 5.43）、基线右束支传导阻滞（OR = 2.80，P = 0.01，95% CI = 1.17 - 6.19）以及TAVR后QRS>150毫秒（OR = 2.16，P = 0.03，95% CI = 1.01 - 4.40）。1组和2组患者30天HAVB的阴性预测值分别为95.0%和93.8%。
TAVR后动态监测时30天HAVB的风险根据TAVR后的心电图表现而异，并且一种三组算法能有效识别HAVB阴性预测值较低的组。
