经导管主动脉瓣置换术降低主动脉瓣狭窄患者严重室性心律失常发生率  

Transcatheter aortic valve replacement reduces the incidence of severe ventricular arrhythmia in patients with aortic valve stenosis

作　　者：王丽娟 汪敏[1] 徐承义[1] 苏晞[1] 宋丹[1] 郭卉[1] 张龙岩 何亚峰[1] WANG Li-juan;WANG Min;XU Cheng-yi;SU Xi;SONG Dan;GUO Hui;ZHANG Long-yan;HE Ya-feng(Department of Cardiology,Wuhan Asia Heart Hospital,Wuhan 430081,China;Department of Cardiology,Wuhan Asia Heart Hospital)

机构地区：[1]武汉亚洲心脏病医院心内科,湖北武汉430081 [2]武汉科技大学医学院,湖北武汉430081

出　　处：《内科急危重症杂志》2021年第3期205-208,260,共5页Journal of Critical Care In Internal Medicine

基　　金：武汉市卫生健康委员会青年项目(重点项目)(No:WX19Q13)。

摘　　要：目的:评估主动脉瓣狭窄(AS)患者经导管主动脉瓣置换(TAVR)术前及术后室性心律失常(VAs)发生率。方法:连续收集自2018年1月1日-2019年12月31日在武汉亚洲心脏病医院接受TAVR治疗的症状性重度AS患者81例,排除TAVR术前存在永久起搏器植入病史、术后因并发症植入永久起搏器、术后30 d内死亡、术前无24 h Holter检查结果及失访的患者共14例,最终67例患者纳入分析。TAVR术前及术后1个月行24 h Holter观察VAs的发生情况。VAs分类依据改良的Lown分级系统。结果:TAVR术前VAs Lown分级为1~2级40例(59.7%),3~4级23例(34.3%)。TAVR术后1个月,VAs 1~2级人群占比升高,但差异无统计学意义(P>0.05)。3~4级人群比例显著降低(P<0.05)。其中,室性心动过速(VT)的发生率从11.9%下降至7.5%,但差异无统计学意义(P>0.05)。结论:VAs常见于AS人群中,TAVR术后1个月严重VAs(改良Lown分级3~4级)的患者比例显著降低,可能与瓣膜置换术后左心室功能改善有关。Objective:To evaluate the incidence of ventricular arrhythmias(VAs)before and after transcatheter aortic valve replacement(TAVR)in patients with aortic valve stenosis(AS).Methods:A total of 81 patients with symptomatic severe AS who received TAVR treatment in Wuhan Asia Heart Hospital from January 1,2018 to December 31,2019 were continuously collected,and those 14 patients with the history of permanent pacemaker implantation before TAVR,with a permanent pacemaker implantation due to complications after TAVR,death within 30 days after surgery,had no 24-h Holter examination results before surgery,and lost to follow-up were excluded.Finally,67 patients were included in the analysis.Before TAVR and 1 month after operation,24-h Holter was performed to observe the occurrence of VAs.The classification of VAs was based on a modified Lown grading system.Results:The VAs Lown classification before TAVR was grade 1 to 2 in 40 cases(59.7%),and grade 3 to 4 in 23 cases(34.3%).One month after TAVR,the proportion of VAs 1 to 2 population increased,but the difference was not statistically significant(P>0.05).The proportion of people in grades 3 to 4 was significantly reduced(P<0.05).Among them,the incidence of ventricular tachycardia(VT)decreased from 11.9%to 7.5%,but the difference was not statistically significant(P>0.05).Conclusion:VAs are common in the AS population.The proportion of patients with severe VAs(modified Lown grade 3 to 4)1 month after TAVR is significantly reduced,which may be related to the improvement of left ventricular function after valve replacement.

关 键 词：主动脉瓣狭窄 经导管主动脉瓣置换术 室性心律失常 

分 类 号：R541.7[医药卫生—心血管疾病]