经导管主动脉瓣置换术后迟发型高度房室传导阻滞的预测因素及起搏器置入风险程度分析

Predictors of delayed high atrioventricular block after transcatheter aortic valve replacement and risk analysis of pacemaker implantation

目的探讨经导管主动脉瓣置换术(transcatheter aortic valve replacement,TAVR)后迟发型高度房室传导阻滞(delayed high atrioventricular block,DH-AVB)的预测因素及起搏器置入风险。方法回顾性分析2019年1月至2022年10月在青岛市市立医院心脏中心行TAVR的85例患者,将其分为TAVR术后DH-AVB组和术后非DH-AVB组,对其资料进行单因素分析和二元logistic回归分析。结果结果显示,瓣膜置入过大率(OR=3.582,95%CI:0.923~13.902,P=0.048)、瓣膜置入深度(OR=3.727,95%CI:1.138~12.204,P=0.030)、术后新发完全性左束支传导阻滞(CLBBB)(OR=5.958,95%CI:1.258~28.220,P=0.025)及术后PR时限延长(OR=1.036,95%CI:1.008~1.065,P=0.011)是TAVR术后发生DH-AVB的独立危险因素。随着传导阻滞的进展,术后DH-AVB组患者有着较高的起搏器置入率(81.82%对18.18%,P<0.001)。结论瓣膜置入过大率、瓣膜置入深度、术后新发CLBBB及术后PR时限延长是TAVR术后发生迟发型高度房室传导阻滞的独立预测因素,术后出现DH-AVB患者起搏器置入的发生率较高。

Objective To investigate the predictive factors of delayed high atrioventricular block(DH-AVB)after transcatheter aortic valve replacement(TAVR)and the risk of pacemaker implantation.Methods Patients who underwent TAVR in the heart center of Qingdao Municipal Hospital from January 2019 to October 2022 were retrospectively analyzed.A total of 85 patients who met the criteria of transcatheter aortic valve replacement were included in this study.They were divided into DH-AVB group after TAVR and non-DH-AVB group after TAVR.The data were analyzed by univariate analysis and binary logistic regression analysis.Results The results showed that the over-rate of valve implantation(OR=3.582,95%CI:0.923-13.902,P=0.048),the depth of valve implantation(OR=3.727,95%CI:1.138-12.204,P=0.030),the new postoperative CLBBB(OR=5.958,95%CI:1.258-28.220,P=0.025)and the prolonged PR time limit(OR=1.036,95%CI:1.008-1.065,P=0.011)were independent risk factors for DH-AVB after TAVR.With the progress of conduction block,patients in DH-AVB group had a higher pacemaker implantation rate(81.82%vs.18.18%,P<0.001).Conclusion The excessive rate of valve implantation,the depth of valve implantation,the new complete left bundle branch block(CLBBB)and the prolonged PR time after operation are independent predictors of delayed complete atrioventricular block after TAVR.The incidence of pacemaker implantation in patients with delayed complete atrioventricular block after operation is higher.