"These results should help in planning future strategies regarding the use and timing of continuous ECG monitoring in TAVR-S3 patients with new conduction disturbances following the procedure," Dr. Josep Rodes-Cabau of Quebec Heart and Lung Institute, Laval University, in Quebec City, Canada, told Reuters Health by email.
"More specifically, the use of non-invasive ECG monitoring during the first 2-4 weeks after discharge may be considered," he said.
New-onset LBBB can be considered the most frequent drawback of TAVR using newer-generation transcatheter heart valve (THV) systems, Dr. Rodes-Cabau and colleagues point out in Heart Rhythm.
In the PARTNER 3 trial, up to one-fifth of patients had new-onset LBBB 30 days after receiving the new-generation balloon-expandable S3 valve, despite the low risk and younger age (mean age, 70 years) of the study participants, they note.
"However, little is known about the arrhythmic burden (specially with respect to bradyarrhythmic events) after hospital discharge in S3 recipients with new-onset LBBB," they say.
To investigate, the study team evaluated 104 consecutive TAVR patients with new-onset persistent LBBB following TAVR with the S3 valve. All of them had a cardiac monitor implanted before leaving the hospital.
They report that 40 patients (38.5%) had at least one significant arrhythmic event, leading to a treatment change in 17 patients (42.5%).
Twenty patients (19.2%) developed significant bradyarrhythmias, including 34 episodes of high-degree atrioventricular or complete heart block (HAVB/CHB) and 251 episodes of severe bradycardia. Half of these patients had at least one episode of HAVB/CHB.
Most HAVB/CHB episodes (60%) occurred within four weeks of hospital discharge. Nine patients (8.7%) had a permanent pacemaker implanted at 12 months based on the cardiac monitor findings.
Dr. Rodes-Cabau told Reuters Health, "Preliminary data have suggested similar arrhythmic event rates with other transcatheter valve systems. We are currently evaluating the late arrhythmic events in a large cohort of patients with new-onset LBBBB following TAVR with a self-expanding valve system."
The researchers say studies are needed to try to identify the factors associated with the late progression or regression of conduction disturbances.
They note that the management of patients with new-onset LBBB after TAVR has been "largely debated since the beginning of TAVR. Different strategies have been used in recent years, ranging from clinical observation to prophylactic PPM implantation, which may be considered according to recent guidelines."
The study had no specific funding. Dr. Rodes-Cabau received institutional research grants from Edwards Lifesciences, Medtronic and Boston Scientific.
SOURCE: https://bit.ly/3gqAPFt Heart Rhythm, online May 30, 2021.
By Megan Brooks
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