Prolonged Continuous Electrocardiographic Monitoring Prior to Transcatheter Aortic Valve Replacement
| Autor: | Emilie Pelletier-Beaumont, Dimitri Kalavrouziotis, Josep Rodés-Cabau, Robert DeLarochellière, Eric Dumont, Siamak Mohammadi, David del Val, Jean-Michel Paradis, Alfredo Nunes Ferreira-Neto, Lluis Asmarats, François Philippon, Guillem Muntané-Carol, Lucia Junquera, Isabelle Nault |
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| Rok vydání: | 2020 |
| Předmět: |
Tachycardia
medicine.medical_specialty business.industry medicine.medical_treatment Atrial fibrillation 030204 cardiovascular system & hematology Right bundle branch block medicine.disease 03 medical and health sciences Stenosis 0302 clinical medicine Valve replacement Aortic valve replacement Aortic valve stenosis Internal medicine Cardiology Medicine 030212 general & internal medicine medicine.symptom Cardiology and Cardiovascular Medicine business Atrioventricular block |
| Zdroj: | JACC: Cardiovascular Interventions. 13:1763-1773 |
| ISSN: | 1936-8798 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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