Raad Mohamad, Greenberg Joshua, Altawil Mahmoud, Lee James, Wang Dee Dee, Oudeif Ahmed, Birchak John, Abdelrahim Elsheikh, Makki Tarek, Mohammed Mustafa, Chehab Omar, Ignatius Abel, Singh Gurjit, Maskoun Waddah, O'Neill Brian, Lahiri Marc, Eng Marvin, Villablanca Pedro, Wyman Janet F, Khan Arfaat, Epstein Andrew E, O'Neill William, Schuger Claudio, Frisoli Tiberio M
Structural Heart Disease Section, Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, Michigan, USA.
Electrophysiology Section, Division of Cardiovascular Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Struct Heart. 2024 Mar 16;8(5):100296. doi: 10.1016/j.shj.2024.100296. eCollection 2024 Sep.
There is no clear consensus regarding the optimal risk stratification of high-degree atrioventricular block (HDAVB) after transcatheter aortic valve replacement (TAVR).
This prospective study sought to determine the utility of the pre- and post-TAVR His-ventricular (HV) interval in the risk stratification of post-TAVR HDAVB. One hundred twenty-one patients underwent an electrophysiology study before and after TAVR. The primary outcome was HDAVB requiring pacemaker implantation within 30 days post-TAVR. A separate retrospective cohort was analyzed to determine the postoperative interval at which the risk of HDAVB is reduced to <5%.
HDAVB occurred in 12 (10%) patients. Baseline right bundle branch block (RBBB) (odds ratio [OR]: 13.6), implant depth >4 mm (OR: 3.9), use of mechanically- or self-expanding valves (OR: 6.3), and post-TAVR HV > 65 ms (OR: 4.9) were associated with increased risk of HDAVB, whereas PR intervals and pre-TAVR HV were not. In patients without baseline RBBB or new persistent left bundle branch block (LBBB), not one patient with post-TAVR HV < 65 ms developed HDAVB. In the separate retrospective cohort (N = 1049), the risk of HDAVB is reduced (<5%) on postoperative days 4 and 3 in patients with pre-TAVR RBBB and post-TAVR persistent LBBB, respectively.
Baseline RBBB, new persistent LBBB, implant depth >4 mm, and a post-TAVR HV ≥ 65 ms were associated with a higher risk of post-TAVR HDAVB, whereas an HV ≤ 65 ms was associated with a lower risk. The pre-TAVR HV was not associated with our outcome, and the delta HV did not have practical incremental prognostic value. Among those without pre-TAVR RBBB or post-TAVR persistent LBBB, no patients with post-TAVR HV < 65 ms developed HDAVB.
关于经导管主动脉瓣置换术（TAVR）后高度房室传导阻滞（HDAVB）的最佳风险分层尚无明确共识。
这项前瞻性研究旨在确定TAVR前后希氏束-心室（HV）间期在TAVR后HDAVB风险分层中的作用。121例患者在TAVR前后接受了电生理检查。主要结局是TAVR后30天内需要植入起搏器的HDAVB。分析了一个单独的回顾性队列，以确定HDAVB风险降至<5%的术后间隔时间。
12例（10%）患者发生了HDAVB。基线右束支传导阻滞（RBBB）（比值比[OR]：13.6）、植入深度>4 mm（OR：3.9）、使用机械或自膨胀瓣膜（OR：6.3）以及TAVR后HV>65毫秒（OR：4.9）与HDAVB风险增加相关，而PR间期和TAVR前HV则无此关联。在无基线RBBB或新发持续性左束支传导阻滞（LBBB）的患者中，TAVR后HV<65毫秒的患者无一发生HDAVB。在单独的回顾性队列（N = 1049）中，TAVR前有RBBB和TAVR后有持续性LBBB的患者，分别在术后第4天和第3天HDAVB风险降低（<5%）。
基线RBBB、新发持续性LBBB、植入深度>4 mm以及TAVR后HV≥65毫秒与TAVR后HDAVB风险较高相关，而HV≤65毫秒与较低风险相关。TAVR前HV与我们的结局无关，HV差值也没有实际的增量预后价值。在那些没有TAVR前RBBB或TAVR后持续性LBBB的患者中，TAVR后HV<65毫秒的患者无一发生HDAVB。
