摘要
目的:探讨经导管主动脉瓣置换术(TAVR)后新发不同程度心脏传导阻滞对术后1年心脏传导的影响。方法:入选2019年7月至2022年10月于阜外华中心血管病医院行TAVR的患者130例,纳入其中术后新发心脏传导阻滞患者56例进行研究。根据心脏传导阻滞程度不同分为轻度阻滞组(n=36)、中度阻滞组(n=9)与重度阻滞组(n=11),并对三组间临床特点及术后1年心脏传导情况进行比较分析。结果:平均随访(8.5±4.1)个月期间,56例TAVR术后新发心脏传导阻滞患者中,46例(82.1%)患者心脏传导阻滞部分或完全恢复,其中28例(50.0%)完全恢复心脏传导,10例(17.9%)患者心脏传导阻滞未恢复。轻度阻滞组中22例(61.1%)完全恢复房室传导,9例(25.0%)部分恢复,5例(13.9%)未恢复;中度阻滞组中,2例(22.2%)完全恢复房室传导,5例(55.6%)部分恢复,2例(22.2%)未恢复。三组间远期房室阻滞差异有统计学意义(P<0.001)。Kaplan-Meier曲线分析显示,轻度阻滞组房室传导恢复比例高于中、重度阻滞组(86.1%vs.77.8%vs.72.7%,logrank P=0.03)。Cox多因素分析显示,高龄(≥75岁,HR=1.204,95%CI:1.051~1.525,P=0.041)和术后重度传导阻滞(HR=1.106,95%CI:1.100~1.616,P=0.031)是TAVR术后1年心脏传导阻滞不恢复的独立危险因素。结论:TAVR术后新发心脏传导阻滞1年后50.0%完全恢复。新发重度心脏传导阻滞和高龄是TAVR术后1年心脏传导阻滞不恢复的独立危险因素。
Objectives:This study aims to explore the impact of new-onset heart conduction block post transcatheter aortic valve replacement(TAVR)on the cardiac conduction status during 1-year follow-up.Methods:A total of 130 patients who completed TAVR surgery at Fuwai Central-China Cardiovascular Hospital from July 2019 to October 2022 were screened.Among them,56 cases with postoperative heart conduction block were selected for analysis.According to the degree of heart block,patients were divided into mild block group(n=36),moderate block group(n=9),and severe block group(n=11).The clinical characteristics and cardiac conduction conditions at 1-year follow-up between different groups were compared.Results:During a mean(8.5±4.1)months follow-up period,10(17.9%)patients had long-term atrioventricular conduction block,and 46(82.1%)patients had partial or complete recovery of heart block,with 28(50.0%)patients with completely recovered cardiac conduction.In the mild block group,22(61.1%)cases were completely recovered,9(25.0%)patients partly recovered,and 5(13.9%)cases uncovered.In the moderate block group,2(22.2%)cases were completely recovered,5(55.6%)patients partly recovered,and 2(22.2%)cases uncovered.Difference in long-term atrioventricular conduction block among three groups was statistically significant(P<0.001).The Kaplan-Meier curve shows that patients with moderate to severe heart block have a higher rate of long-term atrioventricular conduction block(86.1%vs.77.8%vs.72.7%,log-rank P=0.03).Cox multivariate analysis exhibited that old age(≥75 years old,HR=1.204,95%CI:1.051-1.525,P=0.041)and severe heart conduction block(HR=1.106,95%CI:1.100-1.616,P=0.031)are the two independent risk factors for long-term atrioventricular conduction block post TAVR.Conclusions:The ratio of complete cardiac conduction recovery post TAVR is 50.0%.Older age(≥75 year)and newonset severe heart conduction block are independent risk factors for long-term atrioventricular conduction block post TAVR procedure.
作者
马继芳
周游
臧小彪
宋卫锋
陈珂
赵智晗
王现青
赵永辉
付海霞
MA Jifang;ZHOU You;ZANG Xiaobiao;SONG Weifeng;CHEN Ke;ZHAO Zhihan;WANG Xianqing;ZHAO Yonghui;FU Haixia(Department of Cardiology,Central China Subcenter of National Center for Cardiovascular Diseases,Henan Cardiovascular Disease Center,Fuwai Central-China Cardiovascular Hospital,Central China Fuwai Hospital of Zhengzhou University,Zhengzhou 450046,China)
出处
《中国循环杂志》
北大核心
2025年第2期164-169,共6页
Chinese Circulation Journal
基金
河南省医学科技攻关计划(LHGJ20230139)。
关键词
经导管主动脉瓣置换术
起搏器
房室阻滞
心律失常
高龄
transcatheter aortic valve replacement
pacemaker
atrioventricular block
arrhythmia
elderly
