经导管主动脉瓣置换术后新发持续完全性左束支传导阻滞的危险因素及短期预后分析

doi:10.3969/j.issn.1003-9198.2024.05.016

Abstract

Abstract: Objective To analyze the risk factors associated with new-onset persistent complete left bundle branch block (cLBBB) in the elderly patients with aortic stenosis undergoing transcatheter aortic valve replacement (TAVR) and the impact of cLBBB on short-term prognosis. Methods The clinical data of 78 elderly patients who underwent TAVR via femoral artery at the Heart Center of Qingdao Municipal Hospital from January 2019 to August 2022 were retrospectively analyzed, and the patients were divided into the new-onset persistent cLBBB group (n=26 ) and the non-LBBB group (n=52) according to whether cLBBB occurred after TAVR during the hospitalization. The baseline data, the levels of biochemical indexes, CT and cardiac ultrasonography imaging, valve-related and surgery-related data and the prognosis during 6 months of follow-up were compared between the two groups. A multiple Logistic regression model was used to analyze the risk factors of new-onset persistent cLBBB after TAVR. Results Of the 78 patients, 26 patients (33.3%) presented with persistent cLBBB after TAVR. Logistic regression analysis showed that preoperative presence of incomplete LBBB (OR=7.609,95%CI:1.051-55.066), oversize rate of implanted valve ≥17.25% (OR=1.096,95%CI:1.017-1.181) and valve implantation depth≥4.96 mm at sinus-free side (OR=3.633,95%CI:1.363-9.686) were the independent risk factors for new-onset persistent cLBBB after TAVR. During 6 months of follow-up, the new persistent cLBBB group had a higher rate of heart failure rehospitalization (16.0% vs 1.9%, P=0.02) compared to the non-LBBB group. Conclusions Preoperative incomplete LBBB, implantation of large-size valves and deep implantation of coronary sinusless lateral valves are the risk factors of persistent cLBBB after TAVR, and the patients with new-onset cLBBB have a higher risk of rehospitalization due to heart failure.

Key words: transcatheter aortic valve replacement, left bundle branch block, influencing factors, prognosis

CLC Number:

R 654.2

DU Zhaona, JIANG Wenbo, MOU Junyu, YU Chengyun, XIA Wei. Risk factors and prognosis of new continuous complete left bundle branch block in elderly patients undergoing transcatheter aortic valve replacement[J]. Practical Geriatrics, 2024, 38(5): 500-437.

References

[1] CUBERO-GALLEGO H, DAM C, MECA J, et al. Transcatheter aortic valve replacement (TAVR): expanding indications to low-risk patients[J]. Ann Transl Med, 2020,8(15):960.
[2] AVVEDIMENTO M, TANG G. Transcatheter aortic valve replacement (TAVR): recent updates[J]. Prog Cardiovasc Dis, 2021,69:73-83.
[3] 马秋华, 原志飞, 马慧, 等. 莫西沙星致老年人左束支传导阻滞1例[J]. 中国现代应用药学, 2020, 37(4):488-489.
[4] 中国医师协会心血管内科医师分会结构性心脏病专业委员会.中国经导管主动脉瓣置换术临床路径专家共识(2021版)[J]. 中国循环杂志, 2022, 37(1):12-23.
[5] SURAWICZ B, CHILDERS R, DEAL B J, et al. AHA/ACCF/HRS recommendations for the standardization and interpretation of the electrocardiogram: part III: intraventricular conduction disturbances: a scientific statement from the American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology; the American College of Cardiology Foundation; and the Heart Rhythm Society. Endorsed by the International Society for Computerized Electrocardiology[J]. J Am Coll Cardiol, 2009, 53(11):976-981.
[6] CHAMANDI C, BARBANTI M, MUNOZ-GARCIA A, et al. Long-term outcomes in patients with new-onset persistent left bundle branch block following TAVR[J]. JACC Cardiovasc Interv, 2019, 12(12):1175-1184.
[7] AUFFRET V, PURI R, URENA M, et al. Conduction disturbances after transcatheter aortic valve replacement: current status and future perspectives[J]. Circulation, 2017, 136(11):1049-1069.
[8] SASAKI K, IZUMO M, KUWATA S. Clinical impact of new-onset left bundle-branch block after transcatheter aortic valve implantation in the Japanese population- a single high-volume center experience[J]. Circ J, 2020, 84(6):1012-1019.
[9] SAMMOUR Y M, LAK H, CHAHINE J, et al. Clinical and echocardiographic outcomes with new-onset left bundle branch block after SAPIEN-3 transcatheter aortic valve replacement[J]. Catheter Cardiovasc Interv, 2023, 101(1):187-196.
[10] VAN DER BOON R M, HOUTHUIZEN P, NUIS R J, et al. Clinical implications of conduction abnormalities and arrhythmias after transcatheter aortic valve implantation[J]. Curr Cardiol Rep, 2014, 16(1):429.
[11] POLLARI F, VOGT F, GROSSMANN I, et al. Risk of conduction disturbances following different transcatheter aortic valve prostheses: the role of aortic valve calcifications[J]. J Geriatr Cardiol, 2022, 19(3):167-176.
[12] SENESAEL E, CALLE S, KAMOEN V, et al. Progression of incomplete toward complete left bundle branch block: a clinical and electrocardiographic analysis[J]. Ann Noninvasive Electrocardiol, 2020, 25(4):e12732.
[13] BOERLAGE-VAN D K, KOOIMAN K M, YONG Z Y, et al. Predictors and permanency of cardiac conduction disorders and necessity of pacing after transcatheter aortic valve implantation[J]. Pacing Clin Electrophysiol, 2014, 37(11):1520-1529.
[14] AHMAD M, PATEL J N, KIM M, et al. Larger valve size is associated with permanent pacemaker implantation in Edwards SAPIEN 3^TM transcatheter aortic valves[J]. Cureus, 2019, 11(4):e4370.
[15] HUSSER O, PELLEGRINI C, KESSLER T, et al. Predictors of permanent pacemaker implantations and new-onset conduction abnormalities with the SAPIEN 3 balloon-expandable transcatheter heart valve[J]. JACC Cardiovasc Interv, 2016, 9(3):244-254.
[16] KATSANOS S, VAN ROSENDAEL P, KAMPERIDIS V, et al. Insights into new-onset rhythm conduction disorders detected by multi-detector row computed tomography after transcatheter aortic valve implantation[J]. Am J Cardiol, 2014, 114(10):1556-1561.
[17] RODÉS-CABAU J. Optimizing valve implantation depth to win the battle against conduction disturbances post-TAVR[J]. JACC Cardiovasc Interv, 2019, 12(18):1808-1810.
[18] BREITBART P, MINNERS J, HEIN M, et al. Implantation depth and its influence on complications after TAVI with self-expanding valves[J]. Int J Cardiovasc Imaging, 2021, 37(10):3081-3092.
[19] REITER C, LAMBERT T, KELLERMAIR J, et al. Intraprocedural dynamics of cardiac conduction during transcatheter aortic valve implantation: assessment by simultaneous electrophysiological testing[J]. Heart Rhythm, 2021, 18(3):419-425.
[20] CHEN S, CHAU K H, NAZIF T M. The incidence and impact of cardiac conduction disturbances after transcatheter aortic valve replacement[J]. Ann Cardiothorac Surg, 2020, 9(6):452-467.
[21] SCHYMIK G, TZAMALIS P, BRAMLAGE P, et al. Clinical impact of a new left bundle branch block following TAVI implantation: 1-year results of the TAVIK cohort[J]. Clin Res Cardiol, 2015, 104(4):351-362.
[22] FAROUX L, CHEN S, MUNTANÉ-CAROL G, et al. Clinical impact of conduction disturbances in transcatheter aortic valve replacement recipients: a systematic review and meta-analysis[J]. Eur Heart J, 2020, 41(29):2771-2781.
[23] KIM K, KO Y G, SHIM C Y, et al. Impact of new-onset persistent left bundle branch block on reverse cardiac remodeling and clinical outcomes after transcatheter aortic valve replacement[J]. Front Cardiovasc Med, 2022, 9:893878.

Risk factors and prognosis of new continuous complete left bundle branch block in elderly patients undergoing transcatheter aortic valve replacement

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