Non-continuous mobile electrocardiogram monitoring for post-transcatheter aortic valve replacement delayed conduction disorders put to the test. Issue 3 (24th January 2023)

• Record Type: Journal Article
• Authors: De Lucia, Raffaele; Giannini, Cristina; Parollo, Matteo; Barletta, Valentina; Costa, Giulia; Giannotti Santoro, Mario; Primerano, Chiara; Angelillis, Marco; De Carlo, Marco; Zucchelli, Giulio; Bongiorni, Maria Grazia; Petronio, Anna Sonia
• Is Part Of: Europace. Volume 25:Issue 3(2023)
• Page Start: 1116
• Page End: 1125
• Publication Date: 2023-01-24
• Subjects: Delayed conduction disturbances -- Transcatheter aortic valve replacement -- Handheld electrocardiogram -- Mobile health; Arrhythmia -- Treatment -- Periodicals; Cardiac pacing -- Periodicals; Catheter ablation -- Periodicals; Heart -- Physiology -- Periodicals; Electrophysiology -- Periodicals; 617.4120645
• DOI: 10.1093/europace/euac285
• Languages: English
• ISSNs: 1099-5129

Abstract

Abstract: Aims: Permanent pacemaker implantation (PPM-I) remains nowadays the most important drawback of transcatheter aortic valve replacement (TAVR) procedure and the optimal strategy of delayed conduction disturbances (CDs) in these patients is unclear. The study aimed to validate an ambulatory electrocardiogram (ECG) monitoring through a 30 s spot ambulatory digital mobile ECG (A e ECG), by using KardiaMobile-6L device in a 30-day period after TAVR procedure. Methods and results: Between March 2021 and February 2022, we consecutively enrolled all patients undergoing TAVR procedure, except pacemaker (PM) carriers. At discharge, all patients were provided of a KardiaMobile-6L device and a spot digital ECG ( e ECG) recording 1 month schedule. Clinical and follow-up data were collected, and e ECG schedule compliance and recording quality were explored. Among 151 patients without pre-existing PM, 23 were excluded for pre-discharge PPM-I, 18 failed the KardiaMobile-6L training phase, and 10 refused the device. Delayed CDs with a Class I/IIa indication for PPM-I occurred in eight patients (median 6 days). Delayed PPM-I vs. non-delayed PPM-I patients were more likely to have longer PR and QRS intervals at discharge. PR interval at discharge was the only independent predictor for delayed PPM-I at multivariate analysis. The overall e ECG schedule compliance was 96.5%. None clinical adverse events CDs related were documented using this new A e ECG monitoring modality. Conclusion: A strategy of 30 s spot A e ECG is safe and efficacious in delayed CDs monitoring after TAVR procedure with a very high e ECG schedule level of compliance. Graphical Abstract: Graphical Abstract (A) Flow chart programme for patient access to the device training phase and its rules. (B) eECG 1 month schedule. (C ) Histogram illustrating the number of cases and associated time to development of delayed CDs requiring PPM-I. CD, conduction disturbance; eECG, digital electrocardiogram; PPM-I, permanent pacemaker implantation.