Arrhythmias Wrongfully Linked to TAVR?

Continuous electrocardiographic monitoring pre-transcatheter aortic valve replacement (TAVR) detected arrhythmic events in almost half the patients analyzed in this study (which will be published soon in JACC Interventions). A fourth of these patients needed urgent therapeutic actions before the procedure.

Previous conduction disorders—particularly, right bundle branch block and chronic renal insufficiency—were linked to a higher risk of arrhythmias.

These previously undiagnosed arrhythmias are too frequent and, as such, we could say that many have been “wrongfully” linked to TAVR—diagnosis is made during post-implantation monitoring, the arrhythmia is considered new and is registered as an event linked to the procedure, when in fact the issue had always been present.

The novelty of this research is using continuous electrocardiographic monitoring to detect the incidence and type of arrhythmic events in candidates for TAVR. It also provides insight into the impact of therapeutic changes secondary to the detection of these unknown arrhythmias.

Read also: High Mortality Rates for Redo Surgery After TAVR.

This was a prospective study including 106 patients with severe aortic stenosis and no prior pacemaker implantation who were screened for TAVR. A prolonged (1 week) continuous electrocardiographic monitoring was conducted within the 3 months leading to the procedure.

Arrhythmic events were detected in 48.1% of patients, and 27.5% of them required treatment.

Atrial fibrillation and tachycardia were detected in 10.1% of subjects, while nonsustained ventricular arrhythmias were detected in 29.2% of patients. Significant bradyarrhythmias were observed in 20.8% of patients, leading to changes in their medication or permanent pacemaker implantation.

Read also: Post TAVR Regression of Ventricular Mass.

The detection of bradyarrhythmias increased up to 30% among patients with pre-existing first-degree atrioventricular block, and up to 47% in those with right bundle branch block.

Chronic renal failure, higher valve calcification, and ventricular dysfunction determined (or tended to determine) an increased risk of undiagnosed arrhythmias.

Post-TAVR events occurred in 22.1% of the population. Previous continuous monitoring expedited diagnosis and decision-making in one-third of patients.

Original Title: Prolonged Continuous Electrocardiographic Monitoring Prior to Transcatheter Aortic Valve Replacement. The PARE Study.

Reference: Lluis Asmarats et al. J Am Coll Cardiol Intv 2020, article in press. https://doi.org/10.1016/j.jcin.2020.03.031.