Background:By virtue of its proximity to structures vital to cardiac conduction, aortomitral continuity calcification (AMCC) may help identify patients at highest risk for developing atrioventricular conduction disease requiring permanent pacemaker implantation (PPMI). We aim to determine the association of AMCC and need for PPMI after transcatheter aortic valve replacement.Methods:Of 614 patients who underwent transcatheter aortic valve replacement (11.8% PPMI rate), we included 136 patients (age 85±8 years, 47% male) without a preexisting intracardiac device or prior valve surgery who underwent preprocedural computed tomography. We analyzed for the presence of AMCC, aortic valve calcification, and mitral annular calcification as well as quantified AMCC and aortic valve calcification score using the Agatston method. We further stratified AMCC score into 3 categories: 0, 1 to 300, and >300. End point was PPMI at 1 month after transcatheter aortic valve replacement.Results:There were 51 (38%) new PPMIs (median time to PPMI, 5 days). Patients who underwent PPMI had a higher prevalence of AMCC than patients without PPMI (69% versus 32%; P<0.0001), as well as higher median AMCC score (263 versus 0; P<0.0001). There was no difference in aortic valve calcification and mitral annular calcification between patients with and without PPMI (all P≥0.09). Patients with AMCC had a 4-fold increase in odds for PPMI compared with those without (adjusted odds ratio, 4.0; P=0.0026). Compared with patients with an AMCC score of 0, patients with an AMCC score >300 had greater than a 5-fold increased odds for PPMI (adjusted odds ratio, 5.7; P=0.0016).Conclusions:Presence of AMCC, particularly with AMCC score >300, is associated with the need for PPMI after transcatheter aortic valve replacement.

中文翻译：

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经导管主动脉瓣置换后主动脉连续性钙化对永久起搏器需求的影响。

背景：由于靠近心脏传导至关重要的结构，主动脉连续性钙化（AMCC）可能有助于确定罹患需要永久起搏器植入（PPMI）的房室传导疾病的最高风险的患者。我们的目的是确定经导管主动脉瓣置换术后AMCC与PPMI需求的关系。方法：在614例行经导管主动脉瓣置换的患者中（11.8％PPMI率），我们纳入了136例患者（年龄85±8岁，男性47％） ），而无需进行手术前的X线断层扫描，而无需使用预先存在的心内装置或进行过瓣膜手术。我们使用Agatston方法分析了AMCC，主动脉瓣钙化和二尖瓣环钙化的存在以及量化的AMCC和主动脉瓣钙化评分。我们进一步将AMCC评分分为3类：0、1至300和> 300。终点是经导管主动脉瓣置换后1个月的PPMI。结果：有51例（38％）新增PPMI（到PPMI的中位时间为5天）。接受PPMI的患者比没有PPMI的患者发生AMCC的发生率更高（69％比32％；P <0.0001），以及更高的中位数AMCC评分（263对0；P <0.0001）。有在主动脉瓣钙化和患者和无PPMI之间二尖瓣环钙化（所有无差异P ≥0.09）。与没有AMCC的患者相比，AMCC患者的PPMI几率增加了4倍（调整后的优势比为4.0；P = 0.0026）。与AMCC得分为0的患者相比，AMCC得分> 300的患者PPMI的增加几率大于5倍（调整后的优势比为5.7; P = 0.0016）。 > 300，与经导管主动脉瓣置换后对PPMI的需求有关。