The Transcatheter Aortic Valve Replacement-Conduction Study: The Value of the His-Ventricular Interval in Risk Stratification for Post-TAVR Atrioventricular-Block

IF 1.4 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS
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引用次数: 0

Abstract

Background

There is no clear consensus regarding the optimal risk stratification of high-degree atrioventricular block (HDAVB) after transcatheter aortic valve replacement (TAVR).

Methods

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%.

Results

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.

Conclusions

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.

经导管主动脉瓣置换-传导研究:His 室间隔在经导管主动脉瓣置换术后房室传导阻滞风险分层中的价值
背景关于经导管主动脉瓣置换术(TAVR)后高位房室传导阻滞(HDAVB)的最佳风险分层,目前还没有明确的共识。这项前瞻性研究旨在确定 TAVR 术前和术后 His-ventricular (HV) 间期在 TAVR 术后 HDAVB 风险分层中的作用。121名患者在TAVR前后接受了电生理学检查。主要结果是TAVR术后30天内需要植入起搏器的HDAVB。对另一个回顾性队列进行了分析,以确定术后HDAVB风险降至<5%的间隔时间。基线右束支传导阻滞(RBBB)(赔率[OR]:13.6)、植入深度4毫米(OR:3.9)、使用机械瓣膜或自扩张瓣膜(OR:6.3)以及TAVR术后HV 65毫秒(OR:4.9)与HDAVB风险增加有关,而PR间期和TAVR术前HV则无关。在没有基线RBBB或新的持续性左束支传导阻滞(LBBB)的患者中,没有一名TAVR后HV超过65毫秒的患者发生HDAVB。在单独的回顾性队列(N = 1049)中,TAVR前RBBB和TAVR后持续性LBBB患者在术后第4天和第3天发生HDAVB的风险分别降低了(<5%)。结论基线RBBB、新的持续性LBBB、植入深度>4 mm和TAVR后HV≥65 ms与TAVR后发生HDAVB的较高风险相关,而HV≤65 ms与较低风险相关。TAVR前的HV与我们的结果无关,δHV也没有实际的增量预后价值。在没有TAVR前RBBB或TAVR后持续LBBB的患者中,没有TAVR后HV < 65 ms的患者发展为HDAVB。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Structural Heart
Structural Heart Medicine-Cardiology and Cardiovascular Medicine
CiteScore
1.60
自引率
0.00%
发文量
81
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