经导管主动脉瓣置换术后迟发性高度房室传导阻滞特征分析

Analysis of the characteristics of delayed high-degree atrioventricular block after transcatheter aortic valve replacement

目的分析经导管主动脉瓣置换术(TAVR)后迟发性高度房室传导阻滞(DHAVB)的特征。方法回顾性纳入四川大学华西医院心脏内科2014年5月至2018年11月间接受自展瓣TAVR的176例患者,其中男101例,女75例,年龄54~92(73±7)岁。收集围手术期及术后30 d随访期的资料。根据术后高度房室传导阻滞(HAVB)的发生情况,除外16例HAVB发生于TAVR后2 d内的患者,剩余160例患者分为无HAVB组(145例)和DHAVB组(15例)。比较两组间基线资料、术中数据、术后即刻心电特征差异,并采用logistic回归模型分析TAVR后DHAVB发生的相关因素。同时,以动态心电图数据为标准评价术后常规心电图对DHAVB的诊断能力。结果DHAVB的发生率为8.5%(15/176),发生时间[M(Q_(1),Q_(3))]为5(4,6)d。相比无HAVB组,DHAVB组术后即刻心电图无新发传导阻滞的占比更低[6/15比66.2%(96/145),P=0.044],而术后即刻心电图新发右束支传导阻滞占比更高[4/15比3.4%(5/145),P=0.002]。多因素logistic回归分析显示术后即刻心电图右束支传导阻滞[OR值(95%CI)为6.60(1.26~34.47),P=0.025]是TAVR后DHAVB发生的相关因素。术后常规心电图诊断DHAVB的特异度为100%(145/145),但灵敏度仅为73.3%(11/15)。结论TAVR患者术后DHAVB发生率也较高,术后即刻心电特征与DHAVB事件相关,应用该特征对患者进行危险分层可优化DHAVB管理。

Objective To investigate the characteristics of delayed high-degree atrioventricular block(DHAVB)after transcatheter aortic valve replacement(TAVR).Methods One hundred and seventy-six patients who underwent TAVR with a self-extending valve between May 2014 and November 2018 in the Department of Cardiology,West China Hospital of Sichuan University,were retrospectively enrolled,including 101 males and 75 females,aged 54-92(73±7)years,and the data were collected during the perioperative and 30 d follow-up periods.According to the occurrence of HAVB after TAVR,160 patients were divided into no-HAVB group(145 cases)and DHAVB group(15 cases),except 16 patients who developed HAVB within 2 days after TAVR.Baseline data,intraoperative data,and immediate postoperative ECG characteristics were compared between the two groups,and logistic regression models were used to analyze the factors associated with the occurrence of DHAVB after TAVR.Meanwhile,the diagnostic ability of the postoperative routine 12-lead ECG for DHAVB was evaluated using the ambulatory ECG findings as the standard diagnosis.Results The incidence of DHAVB was 8.5%(15/176)and occurred at 5(4,6)d.Compared with the no-HAVB group.The percentage of no new conduction block on the immediate postoperative ECG was lower in the DHAVB group[6/15 vs 66.2%(96/145),P=0.044],and the percentage of new right bundle branch block on the immediate postoperative ECG was higher[4/15 vs 3.4%(5/145),P=0.002].Multifactorial logistic regression analysis showed that right bundle branch block on the immediate postoperative ECG[OR(95%CI):6.60(1.26-34.47),P=0.025]was an associated factor for the development of DHAVB after TAVR.The specificity of postoperative routine 12-lead ECG for the diagnosis of DHAVB was 100%(145/145),but the sensitivity was only 73.3%(11/15).Conclusions The incidence of DHAVB after TAVR is also high in Chinese.The immediate postoperative ECG characteristics of patients who underwent TAVR are associated with DHAVB events,and applying these characteristics to risk stratify patients may optimize the management of DHAVB after TAVR.