Bendandi Francesco, Taglieri Nevio, Ciurlanti Leonardo, Mazzapicchi Alessandro, Foroni Marco, Lombardi Laura, Palermo Francesco, Filice Francesco, Ghetti Gabriele, Bruno Antonio Giulio, Orzalkiewicz Mateusz, Costa Giuliano, Frittitta Valentina, Comis Alessandro, Sammartino Sofia, Calì Maria Chiara, Dipietro Elena, Rosa Luigi La, Tamburino Corrado, Palmerini Tullio, Barbanti Marco, Saia Francesco
Cardiology Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna Policlinico S. Orsola, Bologna, Italy.
Cardiology Unit, Ospedale Umberto I, Lugo, Italy.
EuroIntervention. 2025 Jan 20;21(2):e119-e129. doi: 10.4244/EIJ-D-24-00850.
New conduction disturbances are frequent after transcatheter aortic valve implantation (TAVI). Refining our ability to predict high-grade atrioventricular block (AVB) occurring later than 24 hours after the procedure would be useful in order to select patients eligible for early discharge.
This study was designed to identify predictors of high-grade AVB occurring between 24 hours and 30 days after TAVI and to develop and validate a predictive risk score.
We analysed clinical, procedural, and electrocardiographic parameters of 1,290 TAVI patients. Independent predictors of delayed high-grade AVB were used to develop the predictive score, which was then externally validated in a cohort of 936 patients.
Implantation of self-expanding valves, greater implantation depth, longer PR interval in preprocedural electrocardiogram (ECG) and greater increase of PR duration in next-day ECG, preprocedural right bundle branch block (RBBB) and new-onset left bundle branch block or RBBB that persisted in next-day ECG were independent predictors of delayed high-grade AVB and were combined to develop the Delayed atrioventricular block Prediction for eArly disChargE (D-PACE) score. The areas under the curve of the score were 0.879 (95% confidence interval [CI]: 0.835-0.923) and 0.799 (95% CI: 0.730-0.868) in the derivation and validation cohorts, respectively. Based on the score, patients can be classified into three risk categories; low-risk patients demonstrated an incidence of delayed AVB of less than 1% and are ideal candidates for next-day discharge.
The D-PACE score can be used to stratify TAVI patients according to their risk of delayed high-grade AVB and thereby identify those suitable for next-day discharge.
经导管主动脉瓣植入术（TAVI）后新的传导障碍很常见。提高我们预测术后24小时后发生高度房室传导阻滞（AVB）的能力，对于选择适合早期出院的患者很有帮助。
本研究旨在确定TAVI术后24小时至30天发生高度AVB的预测因素，并开发和验证预测风险评分。
我们分析了1290例TAVI患者的临床、手术和心电图参数。延迟高度AVB的独立预测因素用于制定预测评分，然后在936例患者队列中进行外部验证。
自膨胀瓣膜植入、更大的植入深度、术前心电图（ECG）中更长的PR间期以及次日ECG中PR间期的更大增加、术前右束支传导阻滞（RBBB）以及次日ECG中持续存在的新发左束支传导阻滞或RBBB是延迟高度AVB的独立预测因素，并结合起来开发了早期出院延迟房室传导阻滞预测（D-PACE）评分。该评分在推导队列和验证队列中的曲线下面积分别为0.879（95%置信区间[CI]：0.835-0.923）和0.799（95%CI：0.730-0.868）。根据该评分，患者可分为三个风险类别；低风险患者延迟AVB的发生率低于1%，是次日出院的理想人选。
D-PACE评分可用于根据TAVI患者延迟高度AVB的风险进行分层，从而识别适合次日出院的患者。
