Elhadi Mohamed, Alabdaljabar Mohamad S, Lane Conor, Deshmukh Abhishek J, Gulati Rajiv, Cha Yong-Mei, Eleid Mackram F
Division of Interventional Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.
J Soc Cardiovasc Angiogr Interv. 2025 May 27;4(7):103666. doi: 10.1016/j.jscai.2025.103666. eCollection 2025 Jul.
High-grade atrioventricular block (HAVB) is common after transcatheter aortic valve replacement (TAVR). We compared patients with baseline conduction disease that is unchanged on the immediate post-TAVR echocardiogram (ECG) to patients with normal baseline and post-TAVR ECG (control group).
Consecutive patients who underwent TAVR at Mayo Clinic (Rochester, Minnesota) between February 2012 and December 2021 were retrospectively reviewed.
In total, 1069 patients were included in the study: 825 controls, 44 with isolated PR of >240 milliseconds, 93 with left bundle branch block (LBBB), and 107 with right bundle branch block (RBBB). Early HAVB (<24 hours post-TAVR) occurred more frequently in the RBBB group compared with controls (11.2% vs 0.6%; < .001). Early HAVB incidence was similar between the control, isolated PR >240, and LBBB groups (0.6%, 0%, and 1.1%, respectively). Delayed HAVB (>24 hours post-TAVR) was most frequent in the RBBB group (6.5% vs 1.5%; < .001), with higher incidence also observed in PR >240 and LBBB groups compared with that in control (4.5% vs 1.5%; = .14; and 4.3% vs 1.5%; = .06, respectivley). Most of HAVB events in the control, isolated PR >240 and LBBB groups were delayed.
Despite no immediate change in post-TAVR ECG, 17.8% of patients with preexisting RBBB developed HAVB, mostly within 24 hours. This emphasizes the need for inpatient monitoring for at least 24 hours in this group. Conversely, in patients with isolated PR >240 milliseconds and LBBB, the incidence of HAVB was relatively low (5%), with the majority occurring after 24 hours. Potentially, same-day discharge with ambulatory ECG monitoring may be suitable for these patients.
经导管主动脉瓣置换术（TAVR）后，高度房室传导阻滞（HAVB）较为常见。我们将TAVR术后即刻超声心动图（ECG）显示基线传导疾病无变化的患者与基线及TAVR术后ECG均正常的患者（对照组）进行了比较。
对2012年2月至2021年12月在梅奥诊所（明尼苏达州罗切斯特）接受TAVR的连续患者进行回顾性研究。
本研究共纳入1069例患者：825例对照组，44例孤立性PR间期>240毫秒，93例左束支传导阻滞（LBBB），107例右束支传导阻滞（RBBB）。与对照组相比，RBBB组早期HAVB（TAVR术后<24小时）发生率更高（11.2%对0.6%；P<0.001）。对照组、孤立性PR间期>240毫秒组和LBBB组的早期HAVB发生率相似（分别为0.6%、0%和1.1%）。延迟性HAVB（TAVR术后>24小时）在RBBB组最为常见（6.5%对1.5%；P<0.001），PR间期>240毫秒组和LBBB组与对照组相比发生率也更高（分别为4.5%对1.5%；P=0.14；4.3%对1.5%；P=0.06）。对照组、孤立性PR间期>240毫秒组和LBBB组的大多数HAVB事件为延迟性。
尽管TAVR术后ECG无即刻变化，但17.8%的既往有RBBB的患者发生了HAVB，大多在24小时内。这强调了该组患者需要至少住院监测24小时。相反，在孤立性PR间期>240毫秒和LBBB的患者中，HAVB发生率相对较低（5%），大多数发生在24小时后。对于这些患者，门诊ECG监测下当日出院可能是合适的。
