Remote ECG monitoring to reduce complications following transcatheter aortic valve implantations: the Redirect TAVI study

Author:

Natarajan Madhu Kailash1ORCID,Sheth Tej Narendra1,Wijeysundera Harindra Channa2,Chavarria Jorge1ORCID,Rodes-Cabau Josep3,Velianou James Louis1,Radhakrishnan Sam2,Newman Toni1,Smith Amanda1,Wong Jorge Alfredo1ORCID,Schwalm Jon David1,Duong Monica1,Mian Rajibul Islam1,Bishop Marsella Giuliana1,Healey Jeffrey Sean1

Affiliation:

1. Hamilton Health Sciences, Population Health Research Institute, McMaster University , Room 508 – McMaster Clinic, 237 Barton Street East, Hamilton General Hospital, Hamilton, ON , Canada L8L 2X2

2. Schulich Heart Center, Sunnybrook Health Sciences Center, University of Toronto, ICES Toronto , Toronto, ON , Canada

3. Quebec Heart and Lung Institute, Laval University , Quebec City, QC , Canada

Abstract

Abstract Aims The optimal strategy of monitoring for conduction disturbances in patients undergoing transcatheter aortic valve implantation (TAVI) is uncertain. We evaluated a pre- and post-TAVI remote ambulatory cardiac monitoring (rACM) strategy for identification of conduction disturbances and to reduce unplanned pre-discharge post-TAVI permanent pacemaker implantation (PPMI). Methods and results REdireCT TAVI (NCT0381820) was a prospective cohort study of patients referred for outpatient TAVI. Patients with prior PPMI were excluded. Remote ambulatory cardiac monitoring consisted of 2 weeks of continuous electrocardiogram (ECG) monitoring (Pocket-ECGTM) both before and after TAVI. Compliance to monitoring, frequency of notifications, unplanned PPMI post-TAVI, and length of hospitalization were measured. Between June 2018 and March 2020, in 192 undergoing TAVI (mean age: 81.8 years; female sex 46%; balloon-expandable valve 95.3%), compliance to rACM was 91.7% pre-TAVI (mean duration: 12.8 days), and 87.5% post-TAVI (mean duration: 12.9 days). There were 24 (12.5%) rACM notifications (13 pre-TAVI; 11 post-TAVI) resulting in 14 (7.3%) planned PPMI: seven pre-TAVI [due to sinus pauses n = 2 or atrio-ventricular block (AVB) n = 5] and seven post-TAVI [due to sinus pauses n = 1 or AVB n = 5 or ventricular tachycardia (VT) n = 1]. In addition, nine (4.7%) patients received pre-TAVI PPMI due to high-risk baseline ECG (right bundle branch block with hemi-block or prolonged PR interval). Unplanned PPMI post-TAVI during index hospitalization occurred in six (3.1%) patients due to AVB and in one patient readmitted with AVB. The median length of stay post-TAVI was 1 day. Conclusion A strategy of routine rACM was feasible and frequently led to PPMI. Our approach of 2-week rACM both pre- and post-TAVI achieves both high patient compliance and sufficient surveillance. Clinical trial registration Clinical Trial Registration: https://clinicaltrials.gov/ct2/show/NCT03810820

Funder

Ontario Centres of Excellence – Health Technology Fund

Publisher

Oxford University Press (OUP)

Subject

Physiology (medical),Cardiology and Cardiovascular Medicine

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