Different dynamics of new-onset electrocardiographic changes after balloon- and self-expandable transcatheter aortic valve replacement: Implications for prolonged heart rhythm monitoring
Different dynamics of new-onset electrocardiographic changes after balloon- and self-expandable transcatheter aortic valve replacement: Implications for prolonged heart rhythm monitoring
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DOI：
10.1016/j.jelectrocard.2020.01.005
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发表时间：
2020-03-01
影响因子：
1.3
通讯作者：
De Pooter, Jan
中科院分区：
文献类型：
--
作者：
Coeman, Mathieu;Kayaert, Peter;De Pooter, Jan
背景：经导管主动脉瓣置换术（TAVR）后新发心电图（ECG）变化用于评估晚期房室传导阻滞的风险。然而，心电图评估的时间仍存在争议。我们的目的是根据球囊 (BEV) 和自扩张 (SEV) TAVR 的瓣膜设计，比较新发心电图变化的时程和动态。 方法和结果：这项单中心研究连续招募了 133 名 TAVR 患者（28.6% SEV，71.4% BEV）。预先存在永久起搏器植入（PPMI）、手术死亡或心电图登记不完整的患者被排除在外。在手术前、第 1、24、48 和 120 小时以及 1 个月时进行标准 12 导联心电图检查。在 BEV 患者中，没有发生明显的 PR 延长，而在 SEV 患者中，PR 间期显着延长，为 33.7 +/- 22.0 ms（与 TAVR 前相比，p < 0.001），但仅在 TAVR 后 48 小时后出现。 BEV 和 SEV 患者的 QRS 时限延长相当（6.7 +/- 21.5 与 17.0 +/- 26.9 毫秒，p= 0.061），并且在 TAVR 后立即发生。新发左束支传导阻滞见于 18.5% 的 BEV 患者和 30.8% 的 SEV 患者 (p = 0.120)，并且两组均发生在 TAVR 后 24 小时内。与 BEV 患者相比，SEV 患者的晚期 PPMI（TAVR 后 > 24 小时）较高（15.3% 对比 1.5%，p = 0.008）。结论：与球囊扩张瓣膜相比，自扩张瓣膜会导致更多的房室传导损害，且时程延迟。这可能解释了 TAVR 后 24 小时后对起搏器的需求更高。我们的研究结果表明，使用自扩张瓣膜的患者在 TAVR 后需要至少 48 小时心电图监测。 (c) 2020 年由爱思唯尔公司出版。
Background: Newonset electrocardiographic (ECG) changes after transcatheter aortic valve replacement (TAVR) are used to assess the risk for late atrioventricular block. However, the time of ECG evaluation remains controversial. We aimed to compare the time course and dynamics of newonset ECG changes according to valve design in balloon- (BEV) and self-expandable (SEV) TAVR.Methods and results: This single center study enrolled 133 consecutive TAVR patients (28.6% SEV, 71.4% BEV). Patients with pre-existent permanent pacemaker implant (PPMI), procedural death or incomplete ECG registration were excluded. Standard 12-lead ECG was performed before the procedure, at 1, 24, 48 and 120 h and 1 month. In BEV patients, no significant PR prolongation occurred, whereas in SEV patients the PR interval prolonged significantly with 33.7 +/- 22.0 ms (p < 0.001, compared to pre-TAVR) but only after 48 h after TAVR. Widening of QRS duration was comparable among both BEV and SEV patients (6.7 +/- 21.5 versus 17.0 +/- 26.9ms, p= 0.061) and occurred immediately after TAVR. New-onset left bundle branch blockwas seen in 18.5% of BEV and 30.8% of SEV patients (p = 0.120) and occurred within 24 h after TAVR in both groups. Late PPMI (>24 h after TAVR) was higher in SEV compared to BEV patients (15.3% versus 1.5%, p= 0.008).Conclusion: Self-expandable valves cause more impairment in atrioventricular conduction with a delayed time course compared to balloon expandable valves. This might explain the higher pacemaker need beyond 24 h after TAVR. Our findings suggest that patients with self-expandable valves require at least 48 h ECG monitoring post TAVR. (c) 2020 Published by Elsevier Inc.