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| Analysis on predictive factors of permanent pacemaker implantation after transcatheter aortic valve replacement and its prognosis |
| ZHANG Jiaqi CHI Chengwei, LIU Jiyi, ZHAO Weilong, MENG Qingtao, WANG Lidan, SUN Fengzhi, ZHANG Shulong, LIU Jihong |
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Abstract Objective To analyze the incidence rate and predictive factors of permanent pacemaker (PPM) implantation in patients undergoing transcatheter aortic valve replacement (TAVR), and the prognosis of TAVR. Methods Thirty-eight patients with severe aortic valve stenosis were enrolled in our study who had undergone TAVR in our hospital. According to the implantation of PPM one month after operation, they were divided into pacemaker group (8 cases) and non-pacemaker group (30 cases); predictive factors of PPM implantation were analyzed. By the increase or decrease of left ventricular systolic function, they were classified into left ventricular ejection fraction (LVEF)<50% group (15 cases) and LVEF≥50% group (23 cases); the prognosis of the two groups after TAVR was analyzed. ResultsThe incidence rate of PPM implantation after TAVR is 21.1%. Patients with low creatinine clearance, dyslipidemia, high STS morbimortality score, and large T-wave amplitude in lead Ⅰ are at high risk of PPM implantation after TAVR. The main predictors of PPM implantation are new-onset left bundle branch block (Coef 3.170, 95%CI 0.853-7.447, P=0.005) and preoperative large T-wave amplitude in lead Ⅰ(Coef 10.894, 95%CI 1.478-28.012, P=0.018). Mean pressure gradient, aortic valve area and aortic valve area/body surface area are all significantly improved after surgery and during onemonth followup, and so is the left ventricular posterior wall thickness. LVEF, left ventricular enddiastolic diameter and left ventricular septal thickness are significantly improved during the onemonth followup (P<0.05), however, there is no statistically significant difference after surgery(P>0.05). Conclusion New-onset left bundle branch block after TAVR and preoperative large T-wave amplitude in lead Ⅰ are predictive factors of PPM implantation after surgery. Inverse cardiac remodeling occurs in the early phase after TAVR, and heart function and ejection fraction both improve to varying degrees.
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