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De Lucia R, Giannini C, Parollo M, Barletta V, Costa G, Giannotti Santoro M, Primerano C, Angelillis M, De Carlo M, Zucchelli G, Bongiorni MG, Petronio AS. Non-continuous mobile electrocardiogram monitoring for post-transcatheter aortic valve replacement delayed conduction disorders put to the test. Europace 2023; 25:1116-1125. [PMID: 36691737 PMCID: PMC10062351 DOI: 10.1093/europace/euac285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 12/28/2022] [Indexed: 01/25/2023] Open
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 (AeECG), 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 (eECG) recording 1 month schedule. Clinical and follow-up data were collected, and eECG 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 eECG schedule compliance was 96.5%. None clinical adverse events CDs related were documented using this new AeECG monitoring modality. CONCLUSION A strategy of 30 s spot AeECG is safe and efficacious in delayed CDs monitoring after TAVR procedure with a very high eECG schedule level of compliance.
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Affiliation(s)
- Raffaele De Lucia
- Second Division of Cardiology, CardioThoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Cristina Giannini
- Cardiac Catheterization Division, CardioThoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Matteo Parollo
- Second Division of Cardiology, CardioThoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Valentina Barletta
- Second Division of Cardiology, CardioThoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Giulia Costa
- Cardiac Catheterization Division, CardioThoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Mario Giannotti Santoro
- Second Division of Cardiology, CardioThoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Chiara Primerano
- Cardiac Catheterization Division, CardioThoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Marco Angelillis
- Cardiac Catheterization Division, CardioThoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Marco De Carlo
- Cardiac Catheterization Division, CardioThoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Giulio Zucchelli
- Second Division of Cardiology, CardioThoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Maria Grazia Bongiorni
- Second Division of Cardiology, CardioThoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Anna Sonia Petronio
- Cardiac Catheterization Division, CardioThoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
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Nuche J, Panagides V, Nault I, Mesnier J, Paradis JM, de Larochellière R, Kalavrouziotis D, Dumont E, Mohammadi S, Philippon F, Rodés-Cabau J. Incidence and clinical impact of tachyarrhythmic events following transcatheter aortic valve replacement: A review. Heart Rhythm 2022; 19:1890-1898. [PMID: 35952981 DOI: 10.1016/j.hrthm.2022.07.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 07/19/2022] [Accepted: 07/21/2022] [Indexed: 11/24/2022]
Abstract
Transcatheter aortic valve replacement (TAVR) is well established for treating severe symptomatic aortic stenosis. Whereas broad information on the epidemiology, clinical implications, and management of bradyarrhythmias after TAVR is available, data about tachyarrhythmic events remain scarce. Despite the progressively lower risk profile of TAVR patients and the improvement in device characteristics and operator skills, approximately 10% of patients develop new-onset atrial fibrillation (NOAF) after TAVR. The proportion of patients in whom NOAF actually corresponds to previously undiagnosed silent atrial fibrillation (AF) has not been properly determined. The transapical approach, the need for pre- or post- balloon dilation, and the presence of periprocedural complications have been associated with a higher risk of NOAF. Older age, left atrial volume, or worse functional class are patient-derived risk factors shared with preprocedural AF. NOAF after TAVR has been associated with poorer survival and a higher incidence of cerebrovascular events. However, patient management differs markedly among different centers, especially with regard to anticoagulation in patients with short-duration AF episodes detected in the periprocedural setting and in cases of silent NOAF detected during continuous electrocardiographic (ECG) monitoring. Evidence about ventricular arrhythmias is even more scarce than for AF. Some case reports of sudden cardiac death after TAVR in patients with a pacemaker have identified ventricular tachycardia or ventricular fibrillation in device interrogation. TAVR has been shown to reduce the arrhythmic burden, but a significant proportion of patients (16%) present with complex premature ventricular complex arrhythmias within the year after TAVR. Whether these events are related to poorer outcomes is unknown. Continuous ECG monitoring after TAVR may help describe the frequency, risk factors, and prognostic implications of tachyarrhythmias in this population.
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Affiliation(s)
- Jorge Nuche
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Vassili Panagides
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Isabelle Nault
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Jules Mesnier
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Jean-Michel Paradis
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | | | | | - Eric Dumont
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Siamak Mohammadi
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Francois Philippon
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
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Liu X, Fan J, Guo Y, Dai H, Xu J, Wang L, Hu P, Lin X, Li C, Zhou D, Li H, Wang J. Wearable Smartwatch Facilitated Remote Health Management for Patients Undergoing Transcatheter Aortic Valve Replacement. J Am Heart Assoc 2022; 11:e023219. [PMID: 35347997 PMCID: PMC9075450 DOI: 10.1161/jaha.121.023219] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background
In the recent decades, the development of novel digital health technologies enables doctors to monitor ECG and vital signs remotely. But the data on applying the noninvasive wearable smartwatch on patients with transcatheter aortic valve replacement (TAVR) are unknown.
Methods and Results
We performed a prospective, observational cohort study to evaluate the feasibility of a novel, virtual, and remote health care strategy for patients with TAVR discharged to home with smart wearable devices. A total of 100 consecutive patients with severe aortic stenosis who underwent elective transfemoral TAVR were enrolled and received the Huawei smartwatch at least 1 day before TAVR. Vital signs, including heart rate, rhythm, oxygen saturation, and activity, were continuously recorded. Single‐lead ECG was recorded twice per day in the week following TAVR discharge and at least 2 days a week for the subsequent month after TAVR discharge. A designated heart team member provided remote health care with the data from the smartwatch when the patient had a need. Thirty‐eight cardiac events were reported in 34 patients after discharge, with most of the events (76.0%) detected and confirmed by the smartwatch. Six patients were advised and readmitted to the hospital for arrhythmia events detected by the smartwatch, of whom 4 patients received pacemaker implantation. The remaining 28 (82.4%) patients received telemedicine monitoring instead of face‐to‐face clinical visits, and 3 of them received new medication treatment under the online guidance of doctors. New‐onset left branch bundle block was found in 48 patients, with transient characteristics, and recovered spontaneously in 30 patients, and new‐onset atrial fibrillation was detected in 4 patients. There were no significant differences in the average weekly heart rates or the ratio of abnormal or low oxygen saturation when compared with the baseline. The average daily steps increased over time significantly (baseline, 870±1353 steps; first week, 1986±2406 steps; second week, 2707±2716 steps; third week, 3059±3036 steps; fourth week, 3678±3485 steps,
P
<0.001).
Conclusions
Smartwatches can facilitate remote health care for patients discharged to home after undergoing TAVR and enable a novel remote follow‐up strategy. The majority of cardiac clinical events that occurred within 30‐day follow‐up were detected by the smartwatch, mainly because of the record of conduction abnormality.
Registration
URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT04454177.
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Affiliation(s)
- Xianbao Liu
- Department of Cardiology Second Affiliated Hospital Zhejiang University School of Medicine Hangzhou People’s Republic of China
- Zhejiang University School of Medicine Hangzhou People’s Republic of China
| | - Jiaqi Fan
- Department of Cardiology Second Affiliated Hospital Zhejiang University School of Medicine Hangzhou People’s Republic of China
| | - Yuchao Guo
- Department of Cardiology Second Affiliated Hospital Zhejiang University School of Medicine Hangzhou People’s Republic of China
| | - Hanyi Dai
- Zhejiang University School of Medicine Hangzhou People’s Republic of China
| | - Jianguo Xu
- Department of Electrocardiogram Second Affiliated Hospital Zhejiang University School of Medicine Hangzhou People’s Republic of China
| | - Lihan Wang
- Department of Cardiology Second Affiliated Hospital Zhejiang University School of Medicine Hangzhou People’s Republic of China
| | - Po Hu
- Department of Cardiology Second Affiliated Hospital Zhejiang University School of Medicine Hangzhou People’s Republic of China
| | - Xinping Lin
- Department of Cardiology Second Affiliated Hospital Zhejiang University School of Medicine Hangzhou People’s Republic of China
| | - Cheng Li
- Department of Nursing Second Affiliated Hospital Zhejiang University School of Medicine Hangzhou People’s Republic of China
| | - Dao Zhou
- Zhejiang University School of Medicine Hangzhou People’s Republic of China
| | - Huajun Li
- Department of Cardiology Second Affiliated Hospital Zhejiang University School of Medicine Hangzhou People’s Republic of China
| | - Jian’an Wang
- Department of Cardiology Second Affiliated Hospital Zhejiang University School of Medicine Hangzhou People’s Republic of China
- Zhejiang University School of Medicine Hangzhou People’s Republic of China
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Aymond JD, Benn F, Williams CM, Bernard ML, Hiltbold AE, Khatib S, Polin GM, Rogers PA, Tafur Soto JD, Ramee SR, Parrino PE, Falterman JB, Al-Khatib SM, Morin DP. Epidemiology, evaluation, and management of conduction disturbances after transcatheter aortic valve replacement. Prog Cardiovasc Dis 2021; 66:37-45. [PMID: 34332660 DOI: 10.1016/j.pcad.2021.06.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Aortic stenosis is the most common valvulopathy requiring replacement by means of the surgical or transcatheter approach. Transcatheter aortic valve replacement (TAVR) has quickly become a viable and often preferred treatment strategy compared to surgical aortic valve replacement. However, transcatheter heart valve system deployment not infrequently injures the specialized electrical system of the heart, leading to new conduction disorders including high-grade atrioventricular block and complete heart block (CHB) necessitating permanent pacemaker implantation (PPI), which may lead to deleterious effects on cardiac function and patient outcomes. Additional conduction disturbances (e.g., new-onset persistent left bundle branch block, PR/QRS prolongation, and transient CHB) currently lack clearly defined management algorithms leading to variable strategies among institutions. This article outlines the current understanding of the pathophysiology, patient and procedural risk factors, means for further risk stratification and monitoring of patients without a clear indication for PPI, our institutional approach, and future directions in the management and evaluation of post-TAVR conduction disturbances.
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Affiliation(s)
- Joshua D Aymond
- Ochsner Medical Center, New Orleans, LA, United States of America
| | - Francis Benn
- Ochsner Medical Center, New Orleans, LA, United States of America
| | - Cody M Williams
- Ochsner Medical Center, New Orleans, LA, United States of America
| | | | - A Elise Hiltbold
- Ochsner Medical Center, New Orleans, LA, United States of America
| | - Sammy Khatib
- Ochsner Medical Center, New Orleans, LA, United States of America
| | - Glenn M Polin
- Ochsner Medical Center, New Orleans, LA, United States of America
| | - Paul A Rogers
- Ochsner Medical Center, New Orleans, LA, United States of America
| | | | - Stephen R Ramee
- Ochsner Medical Center, New Orleans, LA, United States of America
| | - P Eugene Parrino
- Ochsner Medical Center, New Orleans, LA, United States of America
| | | | - Sana M Al-Khatib
- Ochsner Medical Center, New Orleans, LA, United States of America
| | - Daniel P Morin
- Ochsner Medical Center, New Orleans, LA, United States of America.
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Muntané-Carol G, Philippon F, Nault I, Faroux L, Alperi A, Mittal S, Rodés-Cabau J. Ambulatory Electrocardiogram Monitoring in Patients Undergoing Transcatheter Aortic Valve Replacement: JACC State-of-the-Art Review. J Am Coll Cardiol 2021; 77:1344-1356. [PMID: 33706878 DOI: 10.1016/j.jacc.2020.12.062] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 12/15/2020] [Accepted: 12/18/2020] [Indexed: 12/29/2022]
Abstract
Transcatheter aortic valve replacement (TAVR) has changed the treatment of patients with severe aortic stenosis. However, the occurrence of conduction disturbances has not decreased significantly over time and remains the main drawback of the procedure. In addition, new-onset atrial fibrillation is the most frequent tachyarrhythmia during the hospitalization period and is associated with worse clinical outcomes. However, little is known regarding the incidence and clinical impact of arrhythmic events beyond the periprocedural TAVR period. Ambulatory electrocardiogram (AECG) monitoring has recently emerged as a tool to unravel the complex issue of arrhythmic disorders (bradyarrhythmias and tachyarrhythmias) before and after TAVR. To date, the preliminary results from the initial experience using AECG monitoring systems showed the safety, usefulness, and potential clinical implications of this diagnostic tool in TAVR recipients. This review provides an overview of the current status, clinical implications, and future perspectives of AECG monitoring in the TAVR setting.
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Affiliation(s)
- Guillem Muntané-Carol
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada. https://twitter.com/MuntaneCarol
| | - François Philippon
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Isabelle Nault
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Laurent Faroux
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Alberto Alperi
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Suneet Mittal
- Snyder Center for Comprehensive Atrial Fibrillation and Department of Cardiology at Valley Health System, Ridgewood, New Jersey, USA
| | - Josep Rodés-Cabau
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada; Hospital Clínic de Barcelona, Barcelona, Spain.
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Lilly SM, Deshmukh AJ, Epstein AE, Ricciardi MJ, Shreenivas S, Velagapudi P, Wyman JF. 2020 ACC Expert Consensus Decision Pathway on Management of Conduction Disturbances in Patients Undergoing Transcatheter Aortic Valve Replacement. J Am Coll Cardiol 2020; 76:2391-2411. [DOI: 10.1016/j.jacc.2020.08.050] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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7
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Editorial: TAVR: Can't You Just Feel the Rhythm? CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:479-480. [PMID: 32563525 DOI: 10.1016/j.carrev.2020.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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