Diagnostic yield of patient-triggered events during 14-days-electrocardiographic monitoring after transcatheter aortic valve implantation
A Bettelini, C Moser, F Jordan, J Bruegger, S Knecht, T Serban, R Stump, T Nestelberger, B Schaer, P Krisai, N Schaerli, C Sticherling, F Mahfoud, M Kuehne, P BadertscherAbstract
Background
Wearable ECG patches used after transcatheter aortic valve implantation (TAVI) enable continuous rhythm monitoring and allow patients to report symptoms via trigger buttons and diary entries. However, the correlation between triggered events and clinically relevant arrhythmias after TAVI remains uncertain.
Purpose
We aimed to systematically analyze patient-triggered events and their corresponding rhythm findings during 14-day ECG patch monitoring after TAVI.
Methods
Adult patients undergoing TAVI at a Swiss tertiary centre were prospectively enrolled and monitored with a 14-day ECG patch before discharge. Patients were instructed to record any cardiac-related symptoms using the patch trigger button and/or diary function.
Results
A total of 307 patients (median age 82 years [78–86], 43% female) underwent ECG patch monitoring. Median monitoring duration was 13 days [11 –14]. At least one patient-triggered event was recorded by 100 patients (33%), with a median of 2 triggered events per patient [1–5]. In 27 patients (9%) triggered events occurred exclusively during sinus rhythm without any associated arrhythmia. Atrial fibrillation was detected by continuous monitoring in 82 patients (27%), newly detected in 15 patients (5%). Among AF-patients, 22 (27%) reported symptoms during AF episodes. Pauses were identified in 59 patients (19%) and high-grade atrioventricular (AV) block in 33 patients (11%), with no triggered events during pauses and only one patient (3%) reporting associated symptoms during high-grade AV block. Ventricular tachycardia (≥3 beats) occurred in 154 patients (50%) and was not associated with any patient-triggered events. Supraventricular and ventricular ectopy (PACs, PVCs) were frequently detected and prompted patient activation in 14% and 10% of cases, respectively. On a per-event analysis 404 events were recorded. 53 (13%) were unevaluable due to imprecise diary entries. Of all symptom-reported events, 141 (35%) were not associated with any arrhythmia. The most frequent arrhythmias were PACs (89, 22%) and PVCs (77, 19%), followed by atrial fibrillation (67, 17%). Notably, 34 (8%) events were associated with more than one arrhythmia.
Conclusions
After TAVI, patient-triggered events during ECG patch monitoring poorly reflect objectively detected arrhythmias and substantially underestimate the burden of clinically relevant rhythm disturbances. This highlights the importance of continuous ECG monitoring after TAVI for accurate and safe arrhythmia detection in this high-risk population.Graphical Abstract