Thirty-Day High-Grade Aortic Valve Block Post-Transcatheter Aortic Valve Replacement in Patients Discharged on Heart Rhythm Monitor

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

Abstract

Background

Conduction disease is an important and common complication post-transcatheter aortic valve replacement (TAVR). Previously, we developed a conduction disease risk stratification and management protocol post-TAVR. This study aims to evaluate high-grade aortic valve block (HAVB) incidence and risk factors in a large cohort undergoing ambulatory cardiac monitoring post-TAVR according to conduction risk grouping.

Methods

This single-center, retrospective study evaluated all patients discharged on ambulatory cardiac monitoring between 2016 and 2021 and stratified them into 3 groups based on electrocardiogram predictors of HAVB risk (group 1 [low], group 2 [intermediate], and group 3 [high]). HAVB was defined as ≥2 consecutive nonconducted P waves in sinus rhythm or bradycardia <50 beats/minute with a fixed rate for atrial fibrillation/flutter. Descriptive statistics were used to show the incidence and timeline, while logistic regression was utilized to evaluate predictors of HAVB.

Results

Five hundred twenty-eight patients were included (median age 80 years [74-85]; 43.8% female). Forty-one patients (7.8%) developed HAVB during ambulatory monitoring (68% were asymptomatic). Over a median follow-up of 2 years (1.3-2.7), the overall mortality rate was 15.0% (30-day mortality rate of 0.57%, n = 3). Risk factors for HAVB were male sex (odds ratio [OR] = 2.46, p = 0.02, 95% CI = 1.21-5.43), baseline right bundle branch block (OR = 2.80, p = 0.01, 95% CI = 1.17-6.19), and post-TAVR QRS >150 ​ms (OR = 2.16, p = 0.03, 95% CI = 1.01-4.40). The negative predictive value for patients in groups 1 and 2 for 30-day HAVB was 95.0 and 93.8%, respectively.

Conclusions

The risk of 30-day HAVB post-TAVR on ambulatory monitoring post-TAVR varies according to post-TAVR electrocardiogram findings, and a 3-group algorithm effectively identifies groups with a low negative predictive value for HAVB.

Abstract Image

接受经导管主动脉瓣置换术的出院患者在术后 30 天内出现的高分级主动脉瓣阻滞
背景传导疾病是经导管主动脉瓣置换术(TAVR)术后重要而常见的并发症。此前,我们制定了经导管主动脉瓣置换术后传导疾病风险分层和管理方案。这项单中心回顾性研究评估了 2016 年至 2021 年期间接受非卧床心脏监护出院的所有患者,并根据心电图预测的 HAVB 风险将其分为 3 组(第 1 组[低]、第 2 组[中]和第 3 组[高])。HAVB的定义是窦性心律或心动过缓<50次/分(心房颤动/扑动的固定频率)时连续出现≥2个非传导性P波。结果纳入了 528 名患者(中位年龄 80 岁 [74-85];43.8% 为女性)。41 名患者(7.8%)在流动监测期间出现了 HAVB(68% 无症状)。中位随访时间为 2 年(1.3-2.7 年),总死亡率为 15.0%(30 天死亡率为 0.57%,n = 3)。HAVB 的风险因素为男性(几率比 [OR] = 2.46,P = 0.02,95% CI = 1.21-5.43)、基线右束支传导阻滞(OR = 2.80,P = 0.01,95% CI = 1.17-6.19)和 TAVR 后 QRS >150 ms(OR = 2.16,P = 0.03,95% CI = 1.01-4.40)。结论 TAVR 术后非卧床监测中,TAVR 术后 30 天 HAVB 的风险因 TAVR 术后心电图结果而异,3 组算法可有效识别 HAVB 阴性预测值较低的组别。
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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