Department of Cardiovascular Surgery, The Sakakibara Heart Institute, Okayama, Japan.
Department of Cardiovascular Surgery, The Sakakibara Heart Institute, Okayama, Japan
Open Heart. 2024 Sep 18;11(2):e002867. doi: 10.1136/openhrt-2024-002867.
Permanent pacemaker implantation (PPMI) is one of the greatest disadvantages of transcatheter aortic valve implantation (TAVI). To seek the predictors and clinical impacts of PPMI and investigate the recovery rate from conduction disorders.
We retrospectively analysed data from 745 consecutive patients who underwent TAVI for severe aortic stenosis from November 2013 to July 2022. The ventricular pacing (VP) rate was recorded at 1 and 6 months after PPMI and the recovery from conduction disorders was defined as the VP rate <1%.
Postoperative PPMI was performed in 7.1% (53/745) of patients. Balloon predilatation was significantly frequent in the PPMI (-) group (52.8% (28/53) vs 80.6% (558/692); p<0.001) and the oversizing ratio was significantly greater in the PPMI (+) group (11.8%±10.1% vs 9.1%±9.7%; p=0.035). Freedom from rehospitalisation due to heart failure rate was significantly higher in the PPMI (-) group (p=0.032). In patients with postoperative PPMI, recovery from conduction disorders was observed in 17.0% and 27.9% of patients at 1 and 6 months, respectively.
Recovery from conduction disorders occurred frequently. Avoidance of oversizing and extension of observation time may reduce the need for PPMI after TAVI.
永久性心脏起搏器植入（PPMI）是经导管主动脉瓣置换术（TAVI）的最大弊端之一。寻找 PPMI 的预测因素和临床影响，并研究传导障碍的恢复率。
我们回顾性分析了 2013 年 11 月至 2022 年 7 月期间 745 例因严重主动脉瓣狭窄接受 TAVI 的连续患者的数据。在 PPMI 后 1 个月和 6 个月记录心室起搏（VP）率，将传导障碍的恢复定义为 VP 率<1%。
7.1%（53/745）的患者术后行 PPMI。在 PPMI（-）组，球囊预扩张更为常见（52.8%（28/53）比 80.6%（558/692）；p<0.001），而 PPMI（+）组的过度扩张率明显更大（11.8%±10.1%比 9.1%±9.7%；p=0.035）。PPMI（-）组因心力衰竭再次住院的比例明显更高（p=0.032）。在术后行 PPMI 的患者中，1 个月和 6 个月时分别有 17.0%和 27.9%的患者恢复了传导功能。
传导障碍的恢复较为常见。避免过度扩张和延长观察时间可能会减少 TAVI 后 PPMI 的需求。
