Remote Ambulatory Cardiac Monitoring Before and After Transcatheter Aortic Valve Replacement

Winter, José Luis; Healey, Jeffrey S.; Sheth, Tej; Velianou, James L.; Schwalm, Jon-David; Smith, Amanda; Reza, Seleman; Natarajan, Madhu K.

doi:10.1016/j.cjco.2020.04.006

Cited by 11 publications

(3 citation statements)

References 15 publications

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“…These results match those observed in earlier studies. 10 , 13 , 14 Anticoagulation treatment was initiated in only 1 patient with persistent Af/af, which was in line with suggestions from the 2021 Journal of the American College of Cardiology State‐of‐the‐Art Review. 8 However, the decision of when to transfer a patient to anticoagulation should be individualized given the higher score of both CHA2DS2‐VASc and HAS‐BLED.…”

Section: Discussionsupporting

confidence: 73%

Wearable Smartwatch Facilitated Remote Health Management for Patients Undergoing Transcatheter Aortic Valve Replacement

Liu

Fan

Guo

et al. 2022

JAHA

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Background In the recent decades, the development of novel digital health technologies enables doctors to monitor ECG and vital signs remotely. But the data on applying the noninvasive wearable smartwatch on patients with transcatheter aortic valve replacement (TAVR) are unknown. Methods and Results We performed a prospective, observational cohort study to evaluate the feasibility of a novel, virtual, and remote health care strategy for patients with TAVR discharged to home with smart wearable devices. A total of 100 consecutive patients with severe aortic stenosis who underwent elective transfemoral TAVR were enrolled and received the Huawei smartwatch at least 1 day before TAVR. Vital signs, including heart rate, rhythm, oxygen saturation, and activity, were continuously recorded. Single‐lead ECG was recorded twice per day in the week following TAVR discharge and at least 2 days a week for the subsequent month after TAVR discharge. A designated heart team member provided remote health care with the data from the smartwatch when the patient had a need. Thirty‐eight cardiac events were reported in 34 patients after discharge, with most of the events (76.0%) detected and confirmed by the smartwatch. Six patients were advised and readmitted to the hospital for arrhythmia events detected by the smartwatch, of whom 4 patients received pacemaker implantation. The remaining 28 (82.4%) patients received telemedicine monitoring instead of face‐to‐face clinical visits, and 3 of them received new medication treatment under the online guidance of doctors. New‐onset left branch bundle block was found in 48 patients, with transient characteristics, and recovered spontaneously in 30 patients, and new‐onset atrial fibrillation was detected in 4 patients. There were no significant differences in the average weekly heart rates or the ratio of abnormal or low oxygen saturation when compared with the baseline. The average daily steps increased over time significantly (baseline, 870±1353 steps; first week, 1986±2406 steps; second week, 2707±2716 steps; third week, 3059±3036 steps; fourth week, 3678±3485 steps, P <0.001). Conclusions Smartwatches can facilitate remote health care for patients discharged to home after undergoing TAVR and enable a novel remote follow‐up strategy. The majority of cardiac clinical events that occurred within 30‐day follow‐up were detected by the smartwatch, mainly because of the record of conduction abnormality. Registration URL: https://www.clinicaltrials.gov ; Unique identifier: NCT04454177.

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Section: Discussionsupporting

confidence: 73%

Wearable Smartwatch Facilitated Remote Health Management for Patients Undergoing Transcatheter Aortic Valve Replacement

Liu

Fan

Guo

et al. 2022

JAHA

View full text Add to dashboard Cite

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“…Several studies have demonstrated that a significant proportion of TAVR candidates displayed HAVB or severe bradyarrhythmia during pre-procedural ECG monitoring either with 24-h in-hospital telemetry [ 59 ] or with ambulatory systems (patch ECG recorder, mobile telemetry), allowing a prolonged (≥7 days) recording [ 60 , 61 ]. Overall, approximately 3% of patients had HAVB episodes pre-TAVR, among whom 2/3 underwent pre-procedural PPI [ 62 ].…”

Section: Unmet Needsmentioning

confidence: 99%

Unmet Needs in TAVR: Conduction Disturbances and Management of Coronary Artery Disease

Auffret

Ridard

Salerno

et al. 2022

JCM

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Over the past two decades, transcatheter aortic valve replacement (TAVR) swiftly evolved from a disrupting technology towards mainstream therapy in the field of severe symptomatic aortic stenosis. A series of randomized evaluations established its role in treating severe aortic stenosis patients across all surgical risk categories, paving the way for an extension of its indications to younger low-risk patients with a longer life expectancy. Therefore, managing comorbidities and limiting procedural complications, which may affect long-term outcomes, is of paramount importance. Among those, new-onset conduction disturbances and concomitant coronary artery disease remain two of the most debated issues. In the present review, we will discuss the incidence, prognostic impact, and unmet needs of patients with post-TAVR new-onset conduction disturbances and the ongoing challenges posed by the management of concomitant coronary artery disease.

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“…[ 33 ] Some studies have also suggested ambulatory monitoring for conduction defects and arrhythmias prior to TAVR to increase the sensitivity in detecting risk factors for HAVB which may develop after TAVR. [ 34 , 35 ]…”

Section: Timing Of Heart Blockmentioning

confidence: 99%

Evaluation and Management of Heart Block After Transcatheter Aortic Valve Replacement

et al. 2021

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Transcatheter aortic valve replacement (TAVR) has developed substantially since its inception. Improvements in valve design, valve deployment technologies, preprocedural imaging and increased operator experience have led to a gradual decline in length of hospitalisation after TAVR. Despite these advances, the need for permanent pacemaker implantation for post-TAVR high-degree atrioventricular block (HAVB) has persisted and has well-established risk factors which can be used to identify patients who are at high risk and advise them accordingly. While most HAVB occurs within 48 hours of the procedure, there is a growing number of patients developing HAVB after initial hospitalisation for TAVR due to the trend for early discharge from hospital. Several observation and management strategies have been proposed. This article reviews major known risk factors for HAVB after TAVR, discusses trends in the timing of HAVB after TAVR and reviews some management strategies for observing transient HAVB after TAVR.

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Remote Ambulatory Cardiac Monitoring Before and After Transcatheter Aortic Valve Replacement

Cited by 11 publications

References 15 publications

Wearable Smartwatch Facilitated Remote Health Management for Patients Undergoing Transcatheter Aortic Valve Replacement

Wearable Smartwatch Facilitated Remote Health Management for Patients Undergoing Transcatheter Aortic Valve Replacement

Unmet Needs in TAVR: Conduction Disturbances and Management of Coronary Artery Disease

Evaluation and Management of Heart Block After Transcatheter Aortic Valve Replacement

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