A Streamline Strategy for Indication and Length of Telemetry Monitoring After TAVR

Both indication and length of ECG telemetry monitoring (TM) after transcatheter aortic valve replacement (TAVR) are not well defined.

We hypothesize that a targeted strategy for monitoring conductive disorders (CD) post-TAVR can reduce the need and duration of in-hospital TM without compromising safety.

We prospectively evaluated consecutive patients undergoing transfemoral TAVR between February 2023 and September 2024. Intensive care unit (ICU) transfer for TM was considered when previous right bundle branch block or when new or worsening CD. TM duration was standardized, from 24 to 48 h. The primary endpoint was incidence of severe CD, defined as symptomatic or requiring medical intervention, occurring outside the ICU, at 1-month follow-up.

Among 250 patients included (mean age: 80.53 ± 6.86 years), 138 (55.20%) required TM, mainly due to new left bundle branch block (n = 64, 44.80%). By respecting the protocol, the primary endpoint was achieved for three patients (1.20%, 95% CI: 0.31; 3.77), all related to post-discharge CD occurring after Day 6 and requiring permanent pacemaker implantation (PPI). There were no deaths and no severe in-hospital CD outside the ICU. The PPI rate was 16.80%. The mean ICU length of stay was 1.34 days. Absence of TM was associated with shorter mean global hospitalization duration (1.43 vs. 2.93 days, p < 0.001).

Selective indication and length of TM after TAVR is possible with no in-hospital events, no deaths, and a low rate of rhythmic events after hospital discharge, confirming the safety of this in-hospital strategy. Nearly half of the patients did not require TM, and very short global and ICU lengths were observed.