Non-continuous mobile electrocardiogram monitoring for post-transcatheter aortic valve replacement delayed conduction disorders put to the test

Abstract

Aims: Permanent pacemaker implantation (PPM-I) remains nowadays the most important drawback of transcatheter aortic valve replacement (TAVR) procedure and the optimal strategy of delayed conduction disturbances (CDs) in these patients is unclear. The study aimed to validate an ambulatory electrocardiogram (ECG) monitoring through a 30 s spot ambulatory digital mobile ECG (AeECG), by using KardiaMobile-6L device in a 30-day period after TAVR procedure.

Methods and results: Between March 2021 and February 2022, we consecutively enrolled all patients undergoing TAVR procedure, except pacemaker (PM) carriers. At discharge, all patients were provided of a KardiaMobile-6L device and a spot digital ECG (eECG) recording 1 month schedule. Clinical and follow-up data were collected, and eECG schedule compliance and recording quality were explored. Among 151 patients without pre-existing PM, 23 were excluded for pre-discharge PPM-I, 18 failed the KardiaMobile-6L training phase, and 10 refused the device. Delayed CDs with a Class I/IIa indication for PPM-I occurred in eight patients (median 6 days). Delayed PPM-I vs. non-delayed PPM-I patients were more likely to have longer PR and QRS intervals at discharge. PR interval at discharge was the only independent predictor for delayed PPM-I at multivariate analysis. The overall eECG schedule compliance was 96.5%. None clinical adverse events CDs related were documented using this new AeECG monitoring modality.

Conclusion: A strategy of 30 s spot AeECG is safe and efficacious in delayed CDs monitoring after TAVR procedure with a very high eECG schedule level of compliance.

Keywords: Delayed conduction disturbances; Handheld electrocardiogram; Mobile health; Transcatheter aortic valve replacement.

Graphical Abstract

(A) Flow chart programme for patient access to the device training phase and its rules. (B) eECG 1 month schedule. (C ) Histogram illustrating the number of cases and associated time to development of delayed CDs requiring PPM-I. CD, conduction disturbance; eECG, digital electrocardiogram; PPM-I, permanent pacemaker implantation.

Figure 1

Patient eligibility and enrolment.

Figure 2

(A and B) eECG of patient# 2 showing AF with first RBBB and then alternating BBB; (C and D) eECG of patient# 3 (with dizziness) showing sinus rhythm with 1st AVB and then 2nd AVB type 1. AF, atrial fibrillation; AVB, atrioventricular block; BBB, bundle branch block; eECG, digital electrocardiogram; RBBB, right bundle branch block.