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Recovery of Atrioventricular Conduction in Patients with Heart Block afterTranscatheter Aortic Valve Replacement

在經(jīng)導(dǎo)管主動(dòng)脈瓣置換術(shù)后（TAVR），因高度房室傳導(dǎo)阻滯（HD-AVB）而接受心臟起搏器（PPMS）治療的患者中，已證實(shí)至少有50%的患者恢復(fù)了傳導(dǎo)。有關(guān)這些患者傳導(dǎo)恢復(fù)時(shí)間進(jìn)程的資料以及預(yù)測(cè)傳導(dǎo)早期恢復(fù)的特征很少。

對(duì)需要用球囊和自膨脹瓣膜進(jìn)行主動(dòng)脈瓣置換（TAVR）的患者，術(shù)后我們對(duì)發(fā)生高度房室傳導(dǎo)阻滯（HD-AVB）而安裝心臟起搏器（PPMS）的患者進(jìn)行回顧性研究，串行PPM詢問以檢測(cè)房室傳導(dǎo)功能的恢復(fù)。進(jìn)行分析以確定傳導(dǎo)恢復(fù)的預(yù)測(cè)因子和時(shí)間。

在578例患者中，54（9%）因?yàn)楦叨确渴覀鲗?dǎo)阻滯（HD-AVB）而接受心臟起搏器（PPMS）的治療。通過多元分析，其預(yù)測(cè)因子包括年齡（P = 0.014），右束分支（或7.33 [ 3.64-14.8 ]，P＜0.0001），心房顫動(dòng)（或2.16 [ 1.16-4.05 ]， P = 0.016），和自我膨脹閥（或4.19 [ 2.20-7.97 ]，P＜0.0001）。在安裝心臟起搏器（PPMS）的54例病人中，38例隨訪足以評(píng)估房室傳導(dǎo)功能的恢復(fù)。其中23例（61%）顯示房室結(jié)傳導(dǎo)恢復(fù)? 20例已恢復(fù)了他們的第一次詢問中位數(shù)為22天IQR（14-31）后PPM的位置。該處房室結(jié)傳導(dǎo)恢復(fù)為無統(tǒng)計(jì)學(xué)意義的預(yù)測(cè)因子，包括植入瓣膜的類型。

主動(dòng)脈瓣置換術(shù)后（TAVR），因高度房室傳導(dǎo)阻滯（HD-AVB）而接受心臟起搏器（PPMS）治療的患者大多數(shù)能在隨訪期間恢復(fù)房室傳導(dǎo)的功能，其中大多數(shù)患者傳導(dǎo)恢復(fù)發(fā)生數(shù)周內(nèi)。 這些發(fā)現(xiàn)意味著使心室起搏最小化的程序設(shè)計(jì)可能對(duì)大多數(shù)這類患者是有益的。

原始文獻(xiàn)摘要

Raelson CA1, Gabriels J2, Ruan J2, Ip JE1, Thomas G1, Liu CF1, Cheung JW1, Lerman BB1, Patel A2, Markowitz SM1.  Recovery of Atrioventricular Conduction in Patients with  Heart Block afterTranscatheter Aortic Valve Replacement  J Cardiovasc Electrophysiol. Jul 5,2017. doi: 10.1111/jce.13291. [Epub ahead of print]

Introduction:

Recovery of conduction has been demonstrated in >50% of patients who receive  pacemakers (PPMs) for high-degree atrioventricular block (HD-AVB) after transcatheter aortic valve replacement (TAVR). Little information is available about the time course of conduction recovery in these patients and if any features predict early recovery of Conduction.

Methods: 

A retrospective review was performed of patients who underwent TAVR with balloon and self-expanding valves who required PPMs for HD-AVB. Serial PPM interrogations were analyzed to detect recovery of AV conduction. Analysis was performed to identify predictors and timing of conduction recovery.

Results:

Of a total population of 578 patients, 54 (9%) received PPMs for HD-AVB. In multivariate  analysis, predictors of HD-AVB requiring a PPM included age (p=0.014), right bundle branch block (OR 7.33 [3.64-14.8], p<0.0001), atrial fibrillation (OR 2.16 [1.16-4.05], p=0.016), and self--expanding valves (OR 4.19 [2.20-7.97], p<0.0001). Of the 54 patients who received PPMs, 38 had follow--up sufficient to evaluate AV conduction recovery. Of these, 23 (61%) showed recovery of AV nodal Conduction ?20 had already recovered by their first interrogation a median of 22 days IQR(14-31) post PPM placement. There were no statistically significant predictors of AV nodal conduction recovery, including type of valve implanted.

Conclusions:

A majority of patients who receive PPMs for HD-AVB after TAVR recover AV conduction during follow-up, and in most patients conduction recovery occurs within weeks. These findings imply that programming to minimize ventricular pacing may be beneficial in a majority of these patients.