经导管主动脉瓣置换术后心脏传导阻滞患者房室传导的恢复
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Recovery of Atrioventricular Conduction in Patients with Heart Block afterTranscatheter Aortic Valve Replacement
背景与目的
在经导管主动脉瓣置换术后（TAVR），因高度房室传导阻滞（HD-AVB）而接受心脏起搏器（PPMS）治疗的患者中，已证实至少有50%的患者恢复了传导。有关这些患者传导恢复时间进程的资料以及预测传导早期恢复的特征很少。
方 法
对需要用球囊和自膨胀瓣膜进行主动脉瓣置换（TAVR）的患者，术后我们对发生高度房室传导阻滞（HD-AVB）而安装心脏起搏器（PPMS）的患者进行回顾性研究，串行PPM询问以检测房室传导功能的恢复。进行分析以确定传导恢复的预测因子和时间。
结 果
在578例患者中，54（9%）因为高度房室传导阻滞（HD-AVB）而接受心脏起搏器（PPMS）的治疗。通过多元分析，其预测因子包括年龄（P = 0.014），右束分支（或7.33 [ 3.64-14.8 ]，P＜0.0001），心房颤动（或2.16 [ 1.16-4.05 ]， P = 0.016），和自我膨胀阀（或4.19 [ 2.20-7.97 ]，P＜0.0001）。在安装心脏起搏器（PPMS）的54例病人中，38例随访足以评估房室传导功能的恢复。其中23例（61%）显示房室结传导恢复; 20例已恢复了他们的第一次询问中位数为22天IQR（14-31）后PPM的位置。该处房室结传导恢复为无统计学意义的预测因子，包括植入瓣膜的类型。
结 论
主动脉瓣置换术后（TAVR），因高度房室传导阻滞（HD-AVB）而接受心脏起搏器（PPMS）治疗的患者大多数能在随访期间恢复房室传导的功能，其中大多数患者传导恢复发生数周内。 这些发现意味着使心室起搏最小化的程序设计可能对大多数这类患者是有益的。
原始文献摘要
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.
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