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Systematic Ambulatory ECG Monitoring for Preventing Life-Threatening Cardiovascular Events Following TAVR
Quentin Fischer1, Isabelle Nault1, Pedro Cepas-Guillén1
1Cardiology Department, Quebec Heart and Lung Institute, Laval University, QC, Canada.
Insights
Systematic ambulatory ECG (AECG) monitoring after transcatheter aortic valve replacement (TAVR) significantly reduces life-threatening cardiovascular events, including sudden death and arrhythmic syncope, within the first year. This approach aids in early arrhythmia detection and improved patient outcomes.
Area of Science:
- Cardiology
- Medical Devices
- Clinical Research
Background:
- Transcatheter aortic valve replacement (TAVR) is a common procedure for aortic stenosis.
- The role of ambulatory ECG (AECG) monitoring post-TAVR in preventing major adverse cardiovascular events is not well-established.
- Understanding the impact of systematic AECG monitoring is crucial for optimizing post-TAVR care.
Purpose of the Study:
- To determine if systematic 14-day AECG monitoring after TAVR reduces the incidence of life-threatening cardiovascular events within one year.
- To compare the rates of sudden cardiac death, syncope/presyncope due to arrhythmias, and stroke between patients with and without systematic AECG monitoring.
Main Methods:
- A cohort study involving 1217 patients who underwent TAVR without a permanent pacemaker.
- A group of 211 patients received systematic 14-day AECG monitoring (RECORD registry).
- A control group of 1006 patients did not receive systematic AECG monitoring.
Main Results:
- Systematic AECG monitoring was associated with a significantly lower incidence of the primary composite end point (1.9% vs. 6.6%, aHR 0.27).
- This reduction was primarily driven by lower rates of sudden death or arrhythmic syncope/presyncope (0.9% vs. 4.0%, aHR 0.22).
- New-onset atrial fibrillation was higher in the AECG group (8.9% vs. 1.8%), leading to increased oral anticoagulation use.
Conclusions:
- Systematic AECG monitoring post-TAVR facilitates earlier detection of severe arrhythmias.
- This monitoring strategy is linked to a reduction in life-threatening cardiovascular events within the first year.
- Findings suggest the need for a randomized controlled trial to confirm these benefits.
Background:
Although ambulatory ECG (AECG) monitoring has been assessed after transcatheter aortic valve replacement (TAVR), its impact on life-threatening cardiovascular events remains unclear. This study aimed to evaluate whether systematic AECG monitoring after TAVR reduces life-threatening cardiovascular events during the first year of follow-up.
Methods:
The study included 1217 consecutive patients who underwent TAVR and were discharged without a permanent pacemaker. Of these, 211 consecutive patients received systematic 14-day AECG monitoring at discharge as part of the RECORD (Assessment of Arrhythmic Burden With Post-Procedural Continuous Electrocardiographic Monitoring in Patients Undergoing Transcatheter Aortic Valve Implantation) registry. The remaining 1006 patients who underwent TAVR within the 3 years before and after the registry period without systematic AECG monitoring constituted the control group. The primary end point was a composite of sudden cardiac death, syncope/presyncope due to symptomatic arrhythmias, or stroke at 1-year.
Results:
Baseline and procedural characteristics were similar between groups, except for a higher use of self-expandable valves in the control group (P=0.005). Systematic AECG monitoring was associated with a lower incidence of the primary endpoint (1.9% versus 6.6%; adjusted hazard ratio, 0.27 [0.10-0.74]; P=0.011), mainly driven by a lower rate of sudden death or arrhythmic syncope/presyncope (0.9% versus 4.0%; adjusted hazard ratio, 0.22 [0.05-0.89]; P=0.034). All sudden death cases occurred in the control group, at a median of 96 (33-235) days after TAVR. New-onset atrial fibrillation was diagnosed in 8.9% of the systematic AECG patients (versus 1.8% in the control group; adjusted hazard ratio, 5.31 [2.47-11.38]; P<0.001), leading to new oral anticoagulation in 71.4% of cases. Stroke and permanent pacemaker implantation rates at 1 year were similar between groups, although permanent pacemaker implantation occurred earlier in the AECG group (25 versus 104 days; P<0.001).
Conclusions:
Systematic AECG monitoring after TAVR enabled earlier detection of severe arrhythmias and was associated with fewer life-threatening cardiovascular events within 1 year. These findings support the need for a randomized trial.
Registration:
URL: https://www.clinicaltrials.gov; Unique identifier: NCT04298593.
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