Novel predictors of permanent pacemaker implantation following transcatheter aortic valve replacement  

作　　者：Somto Nwaedozie Haibin Zhang Javad Najjar Mojarrab Param Sharma Paul Yeung Peter Umukoro Deepa Soodi Rachel Gabor Kelley Anderson Romel Garcia-Montilla 

机构地区：[1]Department of Cardiovascular Disease,Marshfield Clinic,Marshfield,WI 54449,United States [2]Hospitalist Medicine,Marshfield Clinic,Marshfield,WI 54449,United States [3]Department of Nephrology,Henry Ford Health System,Detroit,MI 48202,United States [4]Department of Hospital Medicine,Marshfield Clinic,Marshfield,WI 54449,United States [5]Department of Nephrology,Hendricks Regional Health,Danville,IN 46122,United States [6]Clinical Research Center,Marshfield Clinic,Marshfield,WI 54449,United States [7]Department of Trauma Surgery and Surgical Critical Care,Marshfield Clinic,Marshfield,WI 54449,United States

出　　处：《World Journal of Cardiology》2023年第11期582-598,共17页世界心脏病学杂志（英文版）（电子版）

摘　　要：BACKGROUND Conduction and rhythm abnormalities requiring permanent pacemakers(PPM)are short-term complications following transcatheter aortic valve replacement(TAVR),and their clinical outcomes remain conflicting.Potential novel predictors of post-TAVR PPM,like QRS duration,QTc prolongation,and supraventricular arrhythmias,have been poorly studied.AIM To evaluate the effects of baseline nonspecific interventricular conduction delay and supraventricular arrhythmia on post-TAVR PPM requirement and determine the impact of PPM implantation on clinical outcomes.METHODS RESULTS Out of the 357 patients that met inclusion criteria,the mean age was 80 years,188(52.7%)were male,and 57(16%)had a PPM implantation.Baseline demographics,valve type,and cardiovascular risk factors were similar except for type II diabetes mellitus(DM),which was more prevalent in the PPM cohort(59.6%vs 40.7%;P=0.009).The PPM cohort had a significantly higher rate of pre-procedure right bundle branch block,prolonged QRS>120 ms,prolonged QTc>470 ms,and supraventricular arrhythmias.There was a consistently significant increase in the odds ratio(OR)of PPM implantation for every 20 ms increase in the QRS duration above 100 ms:QRS 101-120[OR:2.44;confidence intervals(CI):1.14-5.25;P=0.022],QRS 121-140(OR:3.25;CI:1.32-7.98;P=0.010),QRS 141-160(OR:6.98;CI:3.10-15.61;P<0.001).After model adjustment for baseline risk factors,the OR remained significant for type II DM(aOR:2.16;CI:1.18-3.94;P=0.012),QRS>120(aOR:2.18;CI:1.02-4.66;P=0.045)and marginally significant for supraventricular arrhythmias(aOR:1.82;CI:0.97-3.42;P=0.062).The PPM cohort had a higher adjusted OR of heart failure(HF)hospitalization(aOR:2.2;CI:1.1-4.3;P=0.022)and nonfatal myocardial infarction(MI)(aOR:3.9;CI:1.1-14;P=0.031)without any difference in mortality(aOR:1.1;CI:0.5-2.7;P=0.796)at one year.CONCLUSION Pre-TAVR type II DM and QRS duration>120,regardless of the presence of bundle branch blocks,are predictors of post-TAVR PPM.At 1-year post-TAVR,patients with PPM have higher odds of HF ho

关 键 词：Transcatheter aortic valve replacement Balloon-expandable valve Self-expandable valve Myocardial infarction Left bundle-branch block Nonspecific inter-ventricular defect Coronary artery bypass graft Coronary artery disease 

分 类 号：R654.2[医药卫生—外科学]