Cardiac conduction abnormalities associated with pacemaker implantation after transcatheter aortic valve replacement

PACE - Pacing and Clinical Electrophysiology - Tập 42 Số 7 - Trang 846-852 - 2019
Stephen Cresse1, Trevor Eisenberg1, Carlos Alfonso2, Mauricio G. Cohen2, Eduardo DeMarchena2, David Bergqvist3, Roger G. Carrillo3
1University of Miami Miller School of Medicine, Miami, Florida
2Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida
3Department of Cardiothoracic Surgery, University of Miami, Miller School of Medicine, Miami, Florida

Tóm tắt

AbstractBackgroundComplete heart block is a known complication after transcatheter aortic valve replacement (TAVR), often requiring pacemaker implantation within 24 hours of the procedure. However, clinical markers for delayed progression to complete heart block after TAVR remain unclear.ObjectivesWe examined electrocardiographic data that may correlate with delayed progression to complete heart block and need for pacemaker.MethodsThis is a single‐center retrospective study of 608 patients who underwent TAVR between April 2008 and June 2017. We excluded 164 (27.0%) patients due to having a pacemaker before the procedure or expiring within 24 hours of the procedure (8, 1.3%). We excluded an additional 50 (8.2%) patients who received a pacemaker within 24 hours of the procedure. Electrocardiograms (EKGs) obtained after the procedure were compared to the preprocedural EKG to detect new changes.ResultsLeft bundle branch block, intraventricular conduction delay, left anterior fascicular block, and right bundle branch block were the most commonly seen conduction abnormalities after TAVR (25.1%, 10.9%, 7.5%, and 3.6%, respectively). Both left bundle branch block (odds ratio [OR] = 2.77 [95% confidence interval (CI): 1.24–6.22]) and right bundle branch block (OR = 13.2 [95% CI: 4.18–41.70]) carried an increased risk of pacemaker implantation after TAVR. Additionally, ΔPR greater than 40 ms from baseline also carried an increased risk of pacemaker implantation (OR = 3.53 [95% CI: 1.49–8.37]).ConclusionLeft bundle branch block, right bundle branch block, and ΔPR greater than 40 ms were all associated with delayed progression to complete heart block and need for pacemaker implantation after TAVR.

Từ khóa


Tài liệu tham khảo

10.15420/AER.2015.04.02.81

Regeer MV, 2017, Left bundle branch block after sutureless, transcatheter, and stented biological aortic valve replacement for aortic stenosis, Euro Intervent, 12, 1660

10.1093/eurheartj/eht376

10.1007/s10840-016-0218-2

10.1007/s10840-016-0145-2

10.1007/s00392-017-1093-2

10.1016/j.jjcc.2016.08.008

10.1016/j.jtcvs.2016.11.038

10.1016/j.jcin.2016.07.026

10.1016/j.jcin.2016.08.034

10.1016/j.jcin.2015.09.036

10.1002/ccd.25036

10.1111/jce.13147

1989, Version 13

10.1093/europace/euw174

10.1056/NEJM200008313430903

10.1161/CIRCINTERVENTIONS.115.003635

10.1093/ehjci/jev343

10.1016/j.ijcard.2016.11.063

10.1161/CIRCULATIONAHA.117.028352

10.1016/j.hrthm.2014.10.023

10.1016/j.jcin.2018.04.016

Thông tin
Thông tin xuất bản

PACE - Pacing and Clinical Electrophysiology

Tập 42 Số 7

846-852

Thông tin tác giả