Atrioventricular conduction disorders in aortic valve infective endocarditis - 01/06/24
, Jérôme Hourdain a, Noémie Resseguier b, c, Frédérique Gouriet d, Jean-Paul Casalta d, Florent Arregle a, Sandrine Hubert a, Alberto Riberi e, Jean-Philippe Mouret a, Vartan Mardigyan f, Jean-Claude Deharo a, Gilbert Habib a, 1
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Graphical abstract |
Highlights |
• | HAVB occurred in 11% of patients with aortic IE. |
• | HAVB was associated with severe biological sepsis. |
• | HAVB was associated with periannular extension of infection. |
• | HAVB was associated with prolonged PR interval at admission. |
• | HAVB represented an additional in-hospital mortality marker. |
• | Most patients implanted with PM were not dependent at long-term follow-up. |
Abstract |
Background |
Aortic valve infective endocarditis may be complicated by high-degree atrioventricular block in up to 10–20% of cases.
Aim |
To assess high-degree atrioventricular block occurrence, contributing factors, prognosis and evolution in patients referred for aortic infective endocarditis.
Methods |
Two hundred and five patients referred for aortic valve infective endocarditis between January 2018 and March 2021 were included in this study. A comprehensive assessment of clinical, electrocardiographic, biological, microbiological and imaging data was conducted, with a follow-up carried out over 1 year.
Results |
High-degree atrioventricular block occurred in 22 (11%) patients. In univariate analysis, high-degree atrioventricular block was associated with first-degree heart block at admission (odds ratio 3.1; P=0.015), periannular complication on echocardiography (odds ratio 6.9; P<0.001) and severe biological inflammatory syndrome, notably C-reactive protein (127 vs 90mg/L; P=0.011). In-hospital mortality (12.7%) was higher in patients with high-degree atrioventricular block (odds ratio 4.0; P=0.011) in univariate analysis. Of the 16 patients implanted with a permanent pacemaker for high-degree atrioventricular block and interrogated, only four (25%) were dependent on the pacing function at 1-year follow-up.
Conclusions |
High-degree atrioventricular block is associated with high inflammation markers and periannular complications, especially if first-degree heart block is identified at admission. High-degree atrioventricular block is a marker of infectious severity, and tends to raise the in-hospital mortality rate. Systematic assessment of patients admitted for infective endocarditis suspicion, considering these contributing factors, could indicate intensive care unit monitoring or even temporary pacemaker implantation in those at highest risk.
El texto completo de este artículo está disponible en PDF.Keywords : Aortic valve infective endocarditis, Atrioventricular conduction disorders, Periannular complications, Multimodality imaging, Temporary pacemaker
Abbreviations : AVB, CT, HAVB, IE, OR, PAC, TAVI, TOE, TTE
Esquema
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Vol 117 - N° 5
P. 304-312 - mai 2024 Regresar al número
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Bienvenido a EM-consulte, la referencia de los profesionales de la salud.