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 Between March 2021 and February 2022, we consecutively enrolled all patients undergoing TAVR procedure, except pace- and results maker (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. Graphical Abstract Patients enrollment by device training phase, eECG 1 month schedule program and late PPM-I Post–Transcatheter Aortic Valve Replacement A Device training phase Digital check list Account Willingness to participate to registration the study for one month Ability to use a smartphone Pseudo anonymized account and send and receive registration, guided by study emails authors, who explained how Relatives involved and felt to use the device and the empowered dedicated App Have a smartphone compatible with the mobile ECG device Ability to independently store and send by email a good quality eECG for 3 consecutive times B eECG 1 month schedule C Patients submitted to PPM-I ! 1 2 3 4 5 6 7 10 8 9 10 11 12 13 14 5 3 3 15 16 17 18 19 20 21 1 1 22 23 24 25 26 27 28 0 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 = eECG sending remainder Days post TAVR procedure (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. Numbers