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Prolonged Continuous Electrocardiographic Monitoring Prior to Transcatheter Aortic Valve Replacement: The PARE Study
Lluis Asmarats1, Isabelle Nault1, Alfredo Nunes Ferreira-Neto1
1Quebec Heart and Lung Institute, Laval University, Quebec City, Canada.
Insights
Continuous electrocardiographic monitoring (CEM) detected unknown arrhythmias in nearly half of transcatheter aortic valve replacement (TAVR) candidates, prompting treatment changes in a quarter. Pre-existing conduction issues and renal failure increased arrhythmia risk.
Area of Science:
- Cardiology
- Electrophysiology
- Interventional Cardiology
Background:
- Limited data exists on the pre-procedural arrhythmic burden in patients undergoing transcatheter aortic valve replacement (TAVR).
- Understanding these arrhythmias is crucial for optimizing patient management and outcomes.
Purpose of the Study:
- To determine the incidence and types of unknown arrhythmic events (AEs) in TAVR candidates using prolonged continuous electrocardiographic monitoring (CEM).
- To evaluate the impact of detecting these AEs on therapeutic management prior to TAVR.
Main Methods:
- A prospective study enrolled 106 patients with severe aortic stenosis awaiting TAVR.
- A one-week CEM was performed within three months pre-TAVR.
- Ninety patients proceeded to TAVR after heart team evaluation.
Main Results:
- CEM identified new AEs in 48.1% of patients, leading to treatment changes in 27.5%.
- Significant bradyarrhythmias occurred in 20.8%, with 36.4% requiring treatment changes and 18.2% receiving pacemakers.
- Pre-existing conditions like right bundle branch block and chronic renal failure were associated with a higher AE burden.
Conclusions:
- Prolonged CEM effectively identifies previously unknown AEs in nearly half of TAVR candidates, enabling timely therapeutic interventions.
- Pre-existing conduction disturbances and chronic renal failure are risk factors for AEs in this population.
Objectives:
This study sought to determine, using continuous electrocardiographic monitoring (CEM) pre-transcatheter aortic valve replacement (TAVR), the incidence and type of unknown pre-existing arrhythmic events (AEs) in TAVR candidates, and to evaluate the occurrence and impact of therapeutic changes secondary to the detection of AEs pre-TAVR.
Background:
Scarce data exist on the arrhythmic burden of TAVR candidates (pre-procedure).
Methods:
This was a prospective study including 106 patients with severe aortic stenosis and no prior permanent pacemaker screened for TAVR. A prolonged (1 week) CEM was implanted within the 3 months pre-TAVR. Following heart team evaluation, 90 patients underwent elective TAVR.
Results:
New AEs were detected by CEM in 51 (48.1%) patients, leading to a treatment change in 14 of 51 (27.5%) patients. Atrial fibrillation or tachycardia was detected in 8 of 79 (10.1%) patients without known atrial fibrillation or tachycardia, and nonsustained ventricular arrhythmias were detected in 31 (29.2%) patients. Significant bradyarrhythmias were observed in 22 (20.8%) patients, leading to treatment change and permanent pacemaker in 8 of 22 (36.4%) and 4 of 22 (18.2%) patients, respectively. The detection of bradyarrhythmias increased up to 30% and 47% among those patients with pre-existing first-degree atrioventricular block and right bundle branch block, respectively. Chronic renal failure, higher valve calcification, and left ventricular dysfunction determined (or tended to determine) an increased risk of AEs pre-TAVR (p = 0.028, 0.052, and 0.069, respectively). New onset AEs post-TAVR occurred in 22.1% of patients, and CEM pre-TAVR allowed early arrhythmia diagnosis in one-third of them.
Conclusions:
Prolonged CEM in TAVR candidates allowed identification of previously unknown AEs in nearly one-half of the patients, leading to prompt therapeutic measures (pre-TAVR) in about one-fourth of them. Pre-existing conduction disturbances (particularly right bundle branch block) and chronic renal failure were associated with a higher burden of AEs.
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