Author + information
- Received January 22, 2020
- Revision received March 16, 2020
- Accepted March 24, 2020
- Published online August 3, 2020.
- Lluis Asmarats, MD,
- Isabelle Nault, MD,
- Alfredo Nunes Ferreira-Neto, MD,
- Guillem Muntané-Carol, MD,
- David del Val, MD,
- Lucia Junquera, MD,
- Jean-Michel Paradis, MD,
- Robert Delarochellière, MD,
- Siamak Mohammadi, MD,
- Dimitri Kalavrouziotis, MD,
- Eric Dumont, MD,
- Emilie Pelletier-Beaumont, MSc,
- François Philippon, MD and
- Josep Rodés-Cabau, MD∗ (, )@IUCPQ
- ↵∗Address for correspondence:
Dr. Josep Rodés-Cabau, Quebec Heart and Lung Institute, Laval University, 2725 Chemin Ste-Foy, Quebec City, Quebec G1V 4GS, Canada.
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.
- ambulatory electrocardiographic
- aortic valve stenosis
- transcatheter aortic valve replacement
Drs. Asmarats, Muntané-Carol, Del Val, and Junquera were supported by a grant from the Fundación Alfonso Martin Escudero (Madrid, Spain). Dr. Rodés-Cabau holds the Research Chair “Fondation Famille Jacques Larivière” for the Development of Structural Heart Disease Interventions; and has received research institutional grants from Medtronic, Edwards Lifesciences, and Boston Scientific. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Cardiovascular Interventions author instructions page.
- Received January 22, 2020.
- Revision received March 16, 2020.
- Accepted March 24, 2020.
- 2020 American College of Cardiology Foundation
This article requires a subscription or purchase to view the full text. If you are a subscriber or member, click Login or the Subscribe link (top menu above) to access this article.