跨导管大动脉置换后新出现的RBBB:永久心脏起器植入的发生率和危险因素
Yoav Michowitz1, Oren Yagel2, Maayan Shrem1
1Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Jerusalem, Israel; Hadassah Hebrew University, Jerusalem, Israel.
JACC. Clinical electrophysiology
|August 6, 2025
概括
跨导管大动脉置换 (TAVR) 后的右捆分支阻塞 (RBBB) 是罕见的,但可能导致传导系统恶化. 早期识别RBBB和特定心电图变化可以帮助预测需要永久心脏起器植入的需要.
科学领域:
- 心脏病学 心脏病学
- 干预心脏病学 干预心脏病学
- 电子生理学 电子生理学
背景情况:
- 右捆支部阻塞 (RBBB) 是通过导管的大动脉替换 (TAVR) 后的一种罕见并发症.
- 了解其发生率和预测因素对于患者管理至关重要.
研究的目的:
- 为了确定TAVR后新发RBBB的发病率.
- 确定这些患者永久心脏起器植入 (PPI) 的风险因素.
主要方法:
- 在以色列7个中心对7,782个TAVR程序进行了回顾性分析.
- 在TAVR前后进行心电图监测.
- 对于高等级心房阻塞或交替捆绑分支阻塞的绝对节奏指示 (API) 的定义.
主要成果:
- 观察到新发RBBB的TAVR手术发生率为1.000例中5.3.
- 近一半的患者 (46.3%) 在一年内需要PPI,其中36.6%有API.
- 在TAVR后的PR间隔≥228 ms和ΔPR≥24 ms显示了API的预测值.
结论:
- 后TAVR RBBB是罕见的,但与显著的导电系统恶化和高PPI率相关,通常在第一个星期内.
- PR间隔变化 (≥230毫秒) 和PR下降 (≥24毫秒) 可以帮助分层患有逐渐导电恶化的风险的患者.
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