JMIR Publications

ABSTRACT

Background:

There is little data available on the development of arrhythmias in patients at risk of high-degree atrioventricular block (HAVB) or complete heart block (CHB) after transcatheter aortic valve replacement (TAVR).

Objective:

This study sought to explore the incidence and evolution of arrhythmias by monitoring patients with HAVB or CHB risk after TAVR with smartwatch.

Methods:

We analyzed 188 consecutive patients in the prospective SMART TAVR trial. Patients were divided into two groups according to the risk of HAVB or CHB. The incidence and time of arrhythmias and pacemaker implantation within a 30-day follow-up were compared. All arrhythmic events were adjudicated in a central ECG core lab.

Results:

The mean age of the patients was 73.1±7.3 years, of whom 55.9% were men. The mean discharging day after TAVR was 2.0±1.8 days. The patients at higher risk of HAVB or CHB received more pacemaker implantation after discharge (9.6% vs. 1.9%, p = 0.043). The incidence of left bundle branch block was higher in the higher HAVB or CHB risk group (56.3% vs. 32.7%, p = 0.001). The independent predictors for pacemaker implantation were age, baseline atrial fibrillation, baseline RBBB, Mobitz II, and third-degree AVB detected by smartwatch.

Conclusions:

A higher incidence of pacemaker implantation after discharge was observed in patients at a risk of HAVB or CHB. However, the Mobitz II and third-degree AVB detected by smartwatch during follow-up were more valuable indicators to predict pacemaker implantation after discharge from the index TAVR. Clinical Trial: SMART Watch Facilitated Early Discharge in Patients undergoing Transcatheter Aortic Valve Replacement [SMART TAVR study]: NCT04454177