经导管主动脉瓣置换术后预防性永久起搏器植入。

IF 7.7 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Clinical electrophysiology Pub Date : 2025-09-12 DOI:10.1016/j.jacep.2025.07.028

Quentin Fischer, Luis Nombela-Franco, Guillem Muntané-Carol, Gabriela Veiga, Ander Regueiro, Tamim Nazif, Vicenç Serra, Lluis Asmarats, Henrique B Ribeiro, Azeem Latib, Anthony Poulin, Asim N Cheema, Gabriela Tirado-Conte, Joan Antoni Gomez-Hospital, Aritz Gil Ongay, Rami Gabani, Dabit Arzamendi, Michael Brener, Alvaro Calabuig, Andrea Scotti, Marco Antonio S Gelain, Marino Labinaz, Pedro Cepas-Guillén, Mélanie Côté, Juan H Del Portillo, François Philippon, Josep Rodés-Cabau

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引用次数: 0

摘要

背景：经导管主动脉瓣置换术（TAVR）后出现新的传导障碍的患者的处理仍然存在很大争议。目的：本研究的目的是评估TAVR术后预防性永久性起搏器植入（PPI）的发生率和临床影响。方法：这是一项预先指定的促进（预先指定的科学专家小组算法用于经导管主动脉瓣置换术后传导障碍管理的前瞻性应用）试验的亚分析，这是一项前瞻性多中心研究，包括2110名连续未使用起搏器的TAVR患者。如果QRS增大且心电图改变活跃（每日PR或QRS间期连续2天增加≥20 ms），或新发持续QRS>150 ms或PR >240 ms，则考虑预防性PPI。结果：共纳入329例tavr后PPI患者，其中80例（24.3%）有预防指征。预防性PPI的主要适应症（90%）是新发持续性左束支阻滞，QRS >150 ms和/或PR >240 ms。预防性PPI和非预防性PPI患者的30天临床结果相似，但预防性PPI组心室起搏百分比的中位数明显较低（2% vs 73%; P < 0.001），心室起搏百分比的患者比例较高。结论：TAVR后接受PPI的患者中约有四分之一有预防指征。尽管临床结果相似，预防性PPI患者在30天表现出非常低的起搏负担。这些发现将对TAVR后预防性PPI的系统使用提出质疑。[j] .经导管主动脉瓣置换术后传导干扰的预定义科学专家小组算法[j]； contemporary medicine; 2012 - 12

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Prophylactic Permanent Pacemaker Implantation After Transcatheter Aortic Valve Replacement.

Background: The management of patients developing new conduction disturbances after transcatheter aortic valve replacement (TAVR) remains largely debated.

Objectives: The purpose of this study was to evaluate the incidence and clinical impact of prophylactic permanent pacemaker implantation (PPI) after TAVR.

Methods: This was a prespecified subanalysis of the PROMOTE (PRospective Application of a Pre-Specified Scientific Expert Panel AlgOrithm for the Management of COnduction Disturbances Following Transcatheter Aortic Valve Replacement) trial, a prospective multicenter study including 2,110 consecutive patients without prior pacemaker undergoing TAVR. Prophylactic PPI was considered in case of enlarged QRS with active electrocardiogram changes (daily PR or QRS interval increase ≥20 ms during 2 consecutive days), or new-onset persistent with either QRS>150 ms or PR >240 ms.

Results: A total of 329 patients with PPI post-TAVR were included, 80 (24.3%) of which had a prophylactic indication. The main indication (90%) of prophylactic PPI was new-onset persistent left bundle branch block with QRS >150 ms and/or PR >240 ms. The 30-day clinical outcomes were similar in prophylactic and nonprophylactic PPI patients, but the median rate of ventricular pacing percentage was significantly lower in the prophylactic PPI group (2% vs 73%; P < 0.001), with a higher rate of patients with ventricular pacing percentage <1% (42.6% vs 14.5%; P < 0.001). Prophylactic PPI after a positive electrophysiological study (His-Ventricle interval ≥70 ms) did not seem to impact the pacing burden at follow-up (median: 2.0% vs 1.9% in no electrophysiological study patients; P = 0.585).

Conclusions: About one fourth of patients receiving PPI after TAVR had a prophylactic indication. Despite similar clinical outcomes, prophylactic PPI patients exhibited a very low pacing burden at 30 days. These findings would question the systematic use of prophylactic PPI after TAVR. (PRospective Application of a Pre-Specified Scientific Expert Panel AlgOrithm for the Management of COnducton Disturbances Following Transcatheter Aortic Valve Replacement [PROMOTE]; NCT04139616).

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来源期刊

JACC. Clinical electrophysiology CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

10.30

自引率

5.70%

发文量

250

期刊介绍： JACC: Clinical Electrophysiology is one of a family of specialist journals launched by the renowned Journal of the American College of Cardiology (JACC). It encompasses all aspects of the epidemiology, pathogenesis, diagnosis and treatment of cardiac arrhythmias. Submissions of original research and state-of-the-art reviews from cardiology, cardiovascular surgery, neurology, outcomes research, and related fields are encouraged. Experimental and preclinical work that directly relates to diagnostic or therapeutic interventions are also encouraged. In general, case reports will not be considered for publication.