![Large peridevice leaks after left atrial appendage occlusion (LAAO) are incredibly rare and not associated with a greater risk of adverse outcomes, according to new research published in JACC: Clinical Electrophysiology.[1] Smaller residual links are more common, however, and associated with a risk of thromboembolic and bleeding events.](/sites/default/files/styles/top_stories/public/2018-08/olderpatient-doctor.jpg.webp?itok=Cv18wcDr)
Ambulatory electrocardiographic (AECG) monitoring can identify patients who may require a permanent pacemaker (PPM) after transcatheter aortic valve replacement (TAVR), according to a new analysis in JACC: Cardiovascular Interventions.
“TAVR has revolutionized the treatment of aortic stenosis,” wrote first author Guillem Muntané-Carol, of the Quebec Heart and Lung Institute in Canada, and colleagues. “However, the occurrence of new-onset left bundle branch block, transcatheter aortic valve replacement (TAVR) can help identify patients at a higher risk of delayed high-degree atrioventricular block (HAVB) or complete heart black (CHB) leading to PPM implantation remains the most frequent drawback of the procedure, and its management is still under debate. Whereas periprocedural arrhythmic disorders have been largely studied, scarce data exist regarding delayed (>48 hours) events, particularly those occurring after hospital discharge.”
The authors examined prospective data from 459 TAVR patients who underwent AECG monitoring with either the CardioSTAT device manufactured by Icentia or the Zio AT Patch manufactured by iRhythm Technologies. AECG monitoring lasted for 14 days, and then an additional clinical follow-up appointment occurred after 30 days.
No patients included in the study had a PPM at the time of the TAVR procedure.
Overall, delayed HAVB or CHB episodes were seen in 4.6% of patients. Episodes occurred a median of five days following the procedure. Eighty-one percent of patients who had an episode required a PPM. No sudden death or all-cause death was reported after 30 days.
“Systematic AECG monitoring in a large cohort of consecutive TAVR patients revealed the occurrence of delayed HAVB or CHB events in close to 5% of the patients, leading to PPM implantation in most of them,” the authors wrote. “The use of AECG monitoring in a minimalist TAVR approach setting was safe, with no mortality events between hospital discharge and 30-day follow-up.”
When patients appear to face an increased risk of HAVB or CHB episodes after TAVR, perhaps due to baseline right bundle branch block or new-onset conduction disturbances, the authors said AECG monitoring and longer hospitalizations may provide additional value and improve patient care.
“Future studies are warranted,” they concluded.
The full analysis is available here.
Michael has more than 16 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.