Systematic Ambulatory ECG Monitoring for Preventing Life-Threatening Cardiovascular Events Following TAVR.

Background: Although ambulatory ECG (AECG) monitoring has been assessed after transcatheter aortic valve replacement (TAVR), its impact on life-threatening cardiovascular events remains unclear. This study aimed to evaluate whether systematic AECG monitoring after TAVR reduces life-threatening cardiovascular events during the first year of follow-up.

Methods: The study included 1217 consecutive patients who underwent TAVR and were discharged without a permanent pacemaker. Of these, 211 consecutive patients received systematic 14-day AECG monitoring at discharge as part of the RECORD registry. The remaining 1006 patients who underwent TAVR within the 3 years before and after the registry period without systematic AECG monitoring constituted the control group. The primary end point was a composite of sudden cardiac death, syncope/presyncope due to symptomatic arrhythmias, or stroke at 1-year.

Results: Baseline and procedural characteristics were similar between groups, except for a higher use of self-expandable valves in the control group (P=0.005). Systematic AECG monitoring was associated with a lower incidence of the primary end point (1.9% versus 6.6%; adjusted hazard ratio, 0.27 [0.10-0.74]; P=0.011), mainly driven by a lower rate of sudden death or arrhythmic syncope/presyncope (0.9% versus 4.0%; adjusted hazard ratio, 0.22 [0.05-0.89]; P=0.034). All sudden death cases occurred in the control group, at a median of 96 (33-235) days after TAVR. New-onset atrial fibrillation was diagnosed in 8.9% of the systematic AECG patients (versus 1.8% in the control group; adjusted hazard ratio, 5.31 [2.47-11.38]; P<0.001), leading to new oral anticoagulation in 71.4% of cases. Stroke and permanent pacemaker implantation rates at 1 year were similar between groups, although permanent pacemaker implantation occurred earlier in the AECG group (25 versus 104 days; P<0.001).

Conclusions: Systematic AECG monitoring after TAVR enables earlier detection of severe arrhythmias and is associated with fewer life-threatening cardiovascular events within 1 year. These findings support the need for a randomized trial.

Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT04298593.