Heart Rhythm ( IF 5.5 ) Pub Date : 2021-11-18 , DOI: 10.1016/j.hrthm.2021.11.020 Khaldoun G Tarakji 1 , Divyang Patel 1 , Amar Krishnaswamy 1 , Ayman Hussein 1 , Walid Saliba 1 , Bruce L Wilkoff 1 , Kathy Wolski 1 , Lars Svensson 1 , Oussama M Wazni 1 , Samir R Kapadia 1
Background
Bradyarrhythmias leading to permanent pacemaker (PPM) implantation continue to be a complication after transcatheter aortic valve replacement (TAVR).
Objective
The purpose of this study was to assess the prevalence of bradyarrhythmias using an electrocardiographic (ECG) extended rhythm recording in patients pre- and post-TAVR and whether they can predict the need for PPM.
Methods
This was a prospective single-center study in patients undergoing TAVR. Patients received an ECG patch for 2 weeks pre-, immediately post-, and 2–3 months post-TAVR. Caring physicians were blinded to the results of the patch except when predefined urgent arrhythmias were detected. The main outcome was the need for PPM implantation after TAVR.
Results
We enrolled 110 patients, of whom 96 underwent TAVR and were included in the final analysis. Bradyarrhythmias, defined as a pause of 3 seconds or more, occurred in 5.2%, 12.7%, and 7% of patients pre-, immediately post-, and 2–3 months post-TAVR, respectively. PPM implantation occurred in 12 patients (12.5%), of whom 9 (9.4%) underwent implantation during their index hospitalization while 3 (3.1%) required implantation postdischarge for indications other than heart block. No patients required PPM after receiving an ECG patch 2–3 months post-TAVR. Significant baseline predictors for the need for PPM included the presence of right bundle branch block and increased QRS duration. Bradyarrhythmias detected by the ECG patch did not predict the need for PPM at either the index hospitalization or the follow-up period.
Conclusion
Bradyarrhythmias are common and can be detected with extended ECG monitoring before and after TAVR; however, in our study they did not predict the need for PPM after TAVR (ClinicalTrials.gov identifier: NCT03180073).
中文翻译:
在接受经导管主动脉瓣置换术的患者中通过延长节律记录检测到缓慢性心律失常(Brady-TAVR 研究)
背景
导致永久性起搏器 (PPM) 植入的缓慢性心律失常仍然是经导管主动脉瓣置换术 (TAVR) 后的并发症。
客观的
本研究的目的是使用心电图 (ECG) 延长节律记录在 TAVR 前后的患者中评估心动过缓的患病率,以及他们是否可以预测对 PPM 的需求。
方法
这是一项针对接受 TAVR 的患者的前瞻性单中心研究。患者在 TAVR 前 2 周、术后即刻和术后 2-3 个月接受 ECG 贴片。除非检测到预定义的紧急心律失常,否则有爱心的医生对补丁的结果不知情。主要结果是 TAVR 后需要 PPM 植入。
结果
我们招募了 110 名患者,其中 96 名接受了 TAVR 并被纳入最终分析。缓慢性心律失常(定义为 3 秒或更长时间的停顿)分别发生在 TAVR 前、后即刻和 2-3 个月的患者中,分别为 5.2%、12.7% 和 7%。12 名患者 (12.5%) 进行了 PPM 植入,其中 9 名 (9.4%) 在首次住院期间接受了植入,而 3 名 (3.1%) 因心脏传导阻滞以外的适应症需要在出院后植入。在 TAVR 后 2-3 个月接受 ECG 贴片后,没有患者需要 PPM。需要 PPM 的重要基线预测因素包括右束支传导阻滞的存在和 QRS 持续时间增加。ECG 贴片检测到的缓慢性心律失常并不能预测在指数住院或随访期间需要 PPM。
结论
缓慢性心律失常很常见,可以通过 TAVR 前后的扩展心电图监测来检测;然而,在我们的研究中,他们并未预测 TAVR 后需要 PPM(ClinicalTrials.gov 标识符:NCT03180073)。