远程心电图监测降低经导管主动脉瓣植入术后并发症：Redirect TAVI 研究。
Remote ECG monitoring to reduce complications following transcatheter aortic valve implantations: the Redirect TAVI study.
机构信息
Hamilton Health Sciences, Population Health Research Institute, McMaster University, Room 508 - McMaster Clinic, 237 Barton Street East, Hamilton General Hospital, Hamilton, ON, Canada L8L 2X2.
Schulich Heart Center, Sunnybrook Health Sciences Center, University of Toronto, ICES Toronto, Toronto, ON, Canada.
出版信息
Europace. 2022 Oct 13;24(9):1475-1483. doi: 10.1093/europace/euac042.
AIMS
The optimal strategy of monitoring for conduction disturbances in patients undergoing transcatheter aortic valve implantation (TAVI) is uncertain. We evaluated a pre- and post-TAVI remote ambulatory cardiac monitoring (rACM) strategy for identification of conduction disturbances and to reduce unplanned pre-discharge post-TAVI permanent pacemaker implantation (PPMI).
METHODS AND RESULTS
REdireCT TAVI (NCT0381820) was a prospective cohort study of patients referred for outpatient TAVI. Patients with prior PPMI were excluded. Remote ambulatory cardiac monitoring consisted of 2 weeks of continuous electrocardiogram (ECG) monitoring (Pocket-ECGTM) both before and after TAVI. Compliance to monitoring, frequency of notifications, unplanned PPMI post-TAVI, and length of hospitalization were measured. Between June 2018 and March 2020, in 192 undergoing TAVI (mean age: 81.8 years; female sex 46%; balloon-expandable valve 95.3%), compliance to rACM was 91.7% pre-TAVI (mean duration: 12.8 days), and 87.5% post-TAVI (mean duration: 12.9 days). There were 24 (12.5%) rACM notifications (13 pre-TAVI; 11 post-TAVI) resulting in 14 (7.3%) planned PPMI: seven pre-TAVI [due to sinus pauses n = 2 or atrio-ventricular block (AVB) n = 5] and seven post-TAVI [due to sinus pauses n = 1 or AVB n = 5 or ventricular tachycardia (VT) n = 1]. In addition, nine (4.7%) patients received pre-TAVI PPMI due to high-risk baseline ECG (right bundle branch block with hemi-block or prolonged PR interval). Unplanned PPMI post-TAVI during index hospitalization occurred in six (3.1%) patients due to AVB and in one patient readmitted with AVB. The median length of stay post-TAVI was 1 day.
CONCLUSION
A strategy of routine rACM was feasible and frequently led to PPMI. Our approach of 2-week rACM both pre- and post-TAVI achieves both high patient compliance and sufficient surveillance.
CLINICAL TRIAL REGISTRATION
Clinical Trial Registration: https://clinicaltrials.gov/ct2/show/NCT03810820.
目的
经导管主动脉瓣置换术（TAVI）患者传导障碍的监测最佳策略尚不确定。我们评估了 TAVI 前和 TAVI 后远程动态心电图监测（rACM）策略，以识别传导障碍，并减少 TAVI 后计划外的永久性起搏器植入（PPMI）。
方法和结果
REdireCT TAVI（NCT0381820）是一项门诊 TAVI 患者的前瞻性队列研究。排除了先前有 PPMI 的患者。远程动态心电图监测包括 TAVI 前后各 2 周的连续心电图（ECG）监测（Pocket-ECGTM）。监测的依从性、通知频率、TAVI 后计划外的 PPMI 以及住院时间均进行了测量。2018 年 6 月至 2020 年 3 月，192 例接受 TAVI 的患者（平均年龄 81.8 岁；女性 46%；球囊扩张瓣膜 95.3%），TAVI 前 rACM 的依从性为 91.7%（平均持续时间：12.8 天），TAVI 后为 87.5%（平均持续时间：12.9 天）。有 24 例（12.5%）出现 rACM 通知（13 例在 TAVI 前，11 例在 TAVI 后），导致 14 例（7.3%）计划 PPMI：7 例在 TAVI 前（由于窦性停搏 n=2 或房室传导阻滞[AVB] n=5），7 例在 TAVI 后（由于窦性停搏 n=1 或 AVB n=5 或室性心动过速[n=1]）。此外，9 例（4.7%）患者因基线心电图高危（右束支阻滞伴半阻滞或 PR 间期延长）而在 TAVI 前接受 PPMI。索引住院期间发生 6 例（3.1%）AVB 后和 1 例因 AVB 再入院的计划外 TAVI 后 PPMI。TAVI 后中位住院时间为 1 天。
结论
常规 rACM 策略是可行的，并且经常导致 PPMI。我们的方法是在 TAVI 前后进行 2 周的 rACM，既提高了患者的依从性，又进行了充分的监测。
临床试验注册
ClinicalTrials.gov 注册：https://clinicaltrials.gov/ct2/show/NCT03810820。
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