Review on Ambulatory ECG Monitoring in TAVR Patients
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Transcatheter aortic valve replacement (TAVR) has changed the treatment of patients with severe aortic stenosis. However, the occurrence of conduction disturbances has not decreased significantly over time and remains the main drawback of the procedure. In addition, new-onset atrial fibrillation is the most frequent tachyarrhythmia during the hospitalization period and is associated with worse clinical outcomes. However, little is known regarding the incidence and clinical impact of arrhythmic events beyond the periprocedural TAVR period.

Ambulatory electrocardiogram (AECG) monitoring has recently emerged as a tool to unravel the complex issue of arrhythmic disorders (bradyarrhythmias and tachyarrhythmias) before and after TAVR. To date, the preliminary results from the initial experience using AECG monitoring systems showed the safety, usefulness, and potential clinical implications of this diagnostic tool in TAVR recipients. This review provides an overview of the current status, clinical implications, and future perspectives of AECG monitoring in the TAVR setting.

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):

- AECG monitoring among patients undergoing TAVR may be useful in identifying patients at risk for or who develop new conduction defects after TAVR.

- Current evidence suggests that 15% of patients who undergo AECG before TAVR have occult atrial fibrillation or high-grade atrioventricular (AV) block.

- Among patients undergoing AECG after TAVR, high-grade AV block leading to placement of a permanent pacemaker occurred in 9% of patients.

- 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.

- Duration and type of monitoring should be predicated on type of conduction defect.

- 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.

- New-onset atrial fibrillation after TAVR is most likely within the first month, and duration of monitoring for 2-4 weeks may be sufficient.

- Large-scale randomized clinical trials are needed to confirm appropriate use of AECG monitoring type and duration among patients undergoing TAVR.