Review on Ambulatory ECG Monitoring in TAVR Patients

Mar 11, 2021   |  Bina Ahmed, MD, FACC
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Authors:
Muntané-Carol G, Phillippon F, Nault I, et al.
Citation:
Ambulatory Electrocardiogram Monitoring in Patients Undergoing Transcatheter Aortic Valve Replacement: JACC State-of-the-Art Review. J Am Coll Cardiol 2021;77:1344-1356.

The following are key points to remember from this state-of-the-art review on ambulatory electrocardiogram (AECG) monitoring in patients undergoing transcatheter aortic valve replacement (TAVR):

  1. AECG monitoring among patients undergoing TAVR may be useful in identifying patients at risk for or who develop new conduction defects after TAVR.
  2. Current evidence suggests that 15% of patients who undergo AECG before TAVR have occult atrial fibrillation or high-grade atrioventricular (AV) block.
  3. Among patients undergoing AECG after TAVR, high-grade AV block leading to placement of a permanent pacemaker occurred in 9% of patients.
  4. Presence of baseline defects such as right bundle branch block (RBBB) or development of new defects such as left bundle branch block (LBBB) may identify a group of patients who would benefit from AECG monitoring before or after TAVR.
  5. Duration and type of monitoring should be predicated on type of conduction defect.
  6. Life-threatening bradyarrhythmia is more likely to occur in patients with high-risk features such as baseline RBBB or new-onset LBBB within the first few weeks post-TAVR and may be best evaluated using mobile cardiovascular telemetry monitoring.
  7. New-onset atrial fibrillation after TAVR is most likely within the first month, and duration of monitoring for 2-4 weeks may be sufficient.
  8. Large-scale randomized clinical trials are needed to confirm appropriate use of AECG monitoring type and duration among patients undergoing TAVR.

Clinical Topics: Arrhythmias and Clinical EP, Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, Implantable Devices, EP Basic Science, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Cardiac Surgery and Arrhythmias

Keywords: Arrhythmias, Cardiac, Atrial Fibrillation, Atrioventricular Block, Bradycardia, Bundle-Branch Block, Electrocardiography, Electrocardiography, Ambulatory, Heart Conduction System, Pacemaker, Artificial, Telemetry, Transcatheter Aortic Valve Replacement


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