department of Cardiology, Zhejiang University, Hangzhou, China.
J Med Internet Res. 2024 Jul 19;26:e41843. doi: 10.2196/41843.
There are limited data available on the development of arrhythmias in patients at risk of high-degree atrioventricular block (HAVB) or complete heart block (CHB) following transcatheter aortic valve replacement (TAVR).
This study aimed to explore the incidence and evolution of arrhythmias by monitoring patients at risk of HAVB or CHB after TAVR using smartwatches.
We analyzed 188 consecutive patients in the prospective SMART TAVR (smartwatch-facilitated early discharge in patients undergoing TAVR) trial. Patients were divided into 2 groups according to the risk of HAVB or CHB. Patients were required to trigger a single-lead electrocardiogram (ECG) recording and send it to the Heart Health App via their smartphone. Physicians in the central ECG core lab would then analyze the ECG. The incidence and timing of arrhythmias and pacemaker implantation within a 30-day follow-up were compared. All arrhythmic events were adjudicated in a central ECG core lab.
The mean age of the patients was 73.1 (SD 7.3) years, of whom 105 (55.9%) were men. The mean discharge day after TAVR was 2.0 (SD 1.8) days. There were no statistically significant changes in the evolution of atrial fibrillation or atrial flutter, Mobitz I, Mobitz II, and third-degree atrial ventricular block over time in the first month after TAVR. The incidence of the left bundle branch block (LBBB) increased in the first week and decreased in the subsequent 3 weeks significantly (P<.001). Patients at higher risk of HAVB or CHB received more pacemaker implantation after discharge (n=8, 9.6% vs n=2, 1.9%; P=.04). The incidence of LBBB was higher in the group with higher HAVB or CHB risk (n=47, 56.6% vs n=34, 32.4%; P=.001). The independent predictors for pacemaker implantation were age, baseline atrial fibrillation, baseline right bundle branch block, Mobitz II, and third-degree atrioventricular block detected by the smartwatch.
Except for LBBB, no change in arrhythmias was observed over time in the first month after TAVR. A higher incidence of pacemaker implantation after discharge was observed in patients at risk of HAVB or CHB. However, Mobitz II and third-degree atrioventricular block detected by the smartwatch during follow-ups were more valuable indicators to predict pacemaker implantation after discharge from the index TAVR.
ClinicalTrials.gov NCT04454177; https://clinicaltrials.gov/study/NCT04454177.
经导管主动脉瓣置换术（TAVR）后，高危发生高度房室传导阻滞（HAVB）或完全性心脏传导阻滞（CHB）的患者，目前关于心律失常的发展数据有限。
本研究旨在通过智能手表监测 TAVR 后发生 HAVB 或 CHB 风险的患者，探讨心律失常的发生率和演变。
我们分析了前瞻性 SMART TAVR（智能手表辅助 TAVR 患者早期出院）试验中的 188 例连续患者。根据 HAVB 或 CHB 的风险将患者分为 2 组。患者需要通过智能手机触发单导联心电图（ECG）记录并将其发送到 Heart Health App。然后，中心心电图核心实验室的医生将对 ECG 进行分析。比较 30 天随访期间心律失常和起搏器植入的发生率和时间。所有心律失常事件均由中心心电图核心实验室裁决。
患者的平均年龄为 73.1（SD 7.3）岁，其中 105 名（55.9%）为男性。TAVR 后平均出院日为 2.0（SD 1.8）天。在 TAVR 后第一个月内，心房颤动或心房扑动、Mobitz I、Mobitz II 和三度房室传导阻滞的演变没有统计学意义上的变化。左束支传导阻滞（LBBB）的发生率在第一周增加，随后的 3 周显著降低（P<.001）。发生 HAVB 或 CHB 风险较高的患者出院后接受更多的起搏器植入（n=8，9.6%比 n=2，1.9%；P=.04）。发生 HAVB 或 CHB 风险较高的患者 LBBB 发生率较高（n=47，56.6%比 n=34，32.4%；P=.001）。起搏器植入的独立预测因素为年龄、基线心房颤动、基线右束支传导阻滞、智能手表检测到的 Mobitz II 和三度房室传导阻滞。
除 LBBB 外，TAVR 后第一个月内心律失常无时间变化。发生 HAVB 或 CHB 风险较高的患者出院后起搏器植入的发生率较高。然而，随访期间智能手表检测到的 Mobitz II 和三度房室传导阻滞是预测指数 TAVR 后起搏器植入的更有价值的指标。
ClinicalTrials.gov NCT04454177；https://clinicaltrials.gov/study/NCT04454177。
