title: Arrhythmia burden in elderly patients with severe aortic stenosis as determined by continuous electrocardiographic recording: toward a better understanding of arrhythmic events after transcatheter aortic valve replacement.
abstract: BACKGROUND
  This study sought to evaluate the prevalence of previously undiagnosed arrhythmias in candidates for transcatheter aortic valve replacement (TAVR) and to determine the impact on therapy changes and arrhythmic events after the procedure.
  
  
  RESULTS
  A total of 435 candidates for TAVR underwent 24-hour continuous ECG monitoring the day before the procedure. Newly diagnosed arrhythmias were observed in 70 patients (16.1%) before TAVR: paroxysmal atrial fibrillation (AF)/atrial tachycardia (AT) in 28, advanced atrioventricular block or severe bradycardia in 24, nonsustained ventricular tachycardia in 26, and intermittent left bundle-branch block in 3 patients. All arrhythmic events but one were asymptomatic and led to a therapy change in 43% of patients. In patients without known AF/AT, the occurrence of AF/AT during 24-hour ECG recording was associated with a higher rate of 30-day cerebrovascular events (7.1% versus 0.4%; P=0.030). Among the 53 patients with new-onset AF/AT after TAVR, 30.2% had newly diagnosed paroxysmal AF/AT before the procedure. In patients who needed permanent pacemaker implantation after the procedure (n=35), 31.4% had newly diagnosed advanced atrioventricular block or severe bradycardia before TAVR. New-onset persistent left bundle-branch block after TAVR occurred in 37 patients, 8.1% of whom had intermittent left bundle-branch block before the procedure.
  
  
  CONCLUSIONS
  Newly diagnosed arrhythmias were observed in approximately a fifth of TAVR candidates, led to a higher rate of cerebrovascular events, and accounted for a third of arrhythmic events after the procedure. This high arrhythmia burden highlights the importance of an early diagnosis of arrhythmic events in such patients to implement the appropriate therapeutic measures earlier.
authors.affiliation: From the Quebec Heart and Lung Institute, Laval University, Quebec, Quebec, Canada (M.U., I.J.A.-S., H.B.R., R.A., J.P., E.D., F.P., J.R.-C.); Emory University School of Medicine, Atlanta, GA (S.H., V.H.T., V.B., S.L.); St Michael's Hospital, Toronto University, Toronto, Ontario, Canada (A.N.C.); Hospital Universitari Vall d'Hebron, Barcelona, Spain (V.S., J.F.P., B.G.d.B.); Hospital Clínico Universitario de Valladolid, Valladolid, Spain (I.J.A.-S., C.C.); and Hospital Clínico San Carlos de Madrid, Madrid, Spain (L.N.-F.).
authors.forename: Marina
authors.initials: M
authors.lastname: Urena
authors.affiliation: From the Quebec Heart and Lung Institute, Laval University, Quebec, Quebec, Canada (M.U., I.J.A.-S., H.B.R., R.A., J.P., E.D., F.P., J.R.-C.); Emory University School of Medicine, Atlanta, GA (S.H., V.H.T., V.B., S.L.); St Michael's Hospital, Toronto University, Toronto, Ontario, Canada (A.N.C.); Hospital Universitari Vall d'Hebron, Barcelona, Spain (V.S., J.F.P., B.G.d.B.); Hospital Clínico Universitario de Valladolid, Valladolid, Spain (I.J.A.-S., C.C.); and Hospital Clínico San Carlos de Madrid, Madrid, Spain (L.N.-F.).
authors.forename: Salim
authors.initials: S
authors.lastname: Hayek
authors.affiliation: From the Quebec Heart and Lung Institute, Laval University, Quebec, Quebec, Canada (M.U., I.J.A.-S., H.B.R., R.A., J.P., E.D., F.P., J.R.-C.); Emory University School of Medicine, Atlanta, GA (S.H., V.H.T., V.B., S.L.); St Michael's Hospital, Toronto University, Toronto, Ontario, Canada (A.N.C.); Hospital Universitari Vall d'Hebron, Barcelona, Spain (V.S., J.F.P., B.G.d.B.); Hospital Clínico Universitario de Valladolid, Valladolid, Spain (I.J.A.-S., C.C.); and Hospital Clínico San Carlos de Madrid, Madrid, Spain (L.N.-F.).
authors.forename: Asim N
authors.initials: AN
authors.lastname: Cheema
authors.affiliation: From the Quebec Heart and Lung Institute, Laval University, Quebec, Quebec, Canada (M.U., I.J.A.-S., H.B.R., R.A., J.P., E.D., F.P., J.R.-C.); Emory University School of Medicine, Atlanta, GA (S.H., V.H.T., V.B., S.L.); St Michael's Hospital, Toronto University, Toronto, Ontario, Canada (A.N.C.); Hospital Universitari Vall d'Hebron, Barcelona, Spain (V.S., J.F.P., B.G.d.B.); Hospital Clínico Universitario de Valladolid, Valladolid, Spain (I.J.A.-S., C.C.); and Hospital Clínico San Carlos de Madrid, Madrid, Spain (L.N.-F.).
authors.forename: Vicenç
authors.initials: V
authors.lastname: Serra
authors.affiliation: From the Quebec Heart and Lung Institute, Laval University, Quebec, Quebec, Canada (M.U., I.J.A.-S., H.B.R., R.A., J.P., E.D., F.P., J.R.-C.); Emory University School of Medicine, Atlanta, GA (S.H., V.H.T., V.B., S.L.); St Michael's Hospital, Toronto University, Toronto, Ontario, Canada (A.N.C.); Hospital Universitari Vall d'Hebron, Barcelona, Spain (V.S., J.F.P., B.G.d.B.); Hospital Clínico Universitario de Valladolid, Valladolid, Spain (I.J.A.-S., C.C.); and Hospital Clínico San Carlos de Madrid, Madrid, Spain (L.N.-F.).
authors.forename: Ignacio J
authors.initials: IJ
authors.lastname: Amat-Santos
authors.affiliation: From the Quebec Heart and Lung Institute, Laval University, Quebec, Quebec, Canada (M.U., I.J.A.-S., H.B.R., R.A., J.P., E.D., F.P., J.R.-C.); Emory University School of Medicine, Atlanta, GA (S.H., V.H.T., V.B., S.L.); St Michael's Hospital, Toronto University, Toronto, Ontario, Canada (A.N.C.); Hospital Universitari Vall d'Hebron, Barcelona, Spain (V.S., J.F.P., B.G.d.B.); Hospital Clínico Universitario de Valladolid, Valladolid, Spain (I.J.A.-S., C.C.); and Hospital Clínico San Carlos de Madrid, Madrid, Spain (L.N.-F.).
authors.forename: Luis
authors.initials: L
authors.lastname: Nombela-Franco
authors.affiliation: From the Quebec Heart and Lung Institute, Laval University, Quebec, Quebec, Canada (M.U., I.J.A.-S., H.B.R., R.A., J.P., E.D., F.P., J.R.-C.); Emory University School of Medicine, Atlanta, GA (S.H., V.H.T., V.B., S.L.); St Michael's Hospital, Toronto University, Toronto, Ontario, Canada (A.N.C.); Hospital Universitari Vall d'Hebron, Barcelona, Spain (V.S., J.F.P., B.G.d.B.); Hospital Clínico Universitario de Valladolid, Valladolid, Spain (I.J.A.-S., C.C.); and Hospital Clínico San Carlos de Madrid, Madrid, Spain (L.N.-F.).
authors.forename: Henrique B
authors.initials: HB
authors.lastname: Ribeiro
authors.affiliation: From the Quebec Heart and Lung Institute, Laval University, Quebec, Quebec, Canada (M.U., I.J.A.-S., H.B.R., R.A., J.P., E.D., F.P., J.R.-C.); Emory University School of Medicine, Atlanta, GA (S.H., V.H.T., V.B., S.L.); St Michael's Hospital, Toronto University, Toronto, Ontario, Canada (A.N.C.); Hospital Universitari Vall d'Hebron, Barcelona, Spain (V.S., J.F.P., B.G.d.B.); Hospital Clínico Universitario de Valladolid, Valladolid, Spain (I.J.A.-S., C.C.); and Hospital Clínico San Carlos de Madrid, Madrid, Spain (L.N.-F.).
authors.forename: Ricardo
authors.initials: R
authors.lastname: Allende
authors.affiliation: From the Quebec Heart and Lung Institute, Laval University, Quebec, Quebec, Canada (M.U., I.J.A.-S., H.B.R., R.A., J.P., E.D., F.P., J.R.-C.); Emory University School of Medicine, Atlanta, GA (S.H., V.H.T., V.B., S.L.); St Michael's Hospital, Toronto University, Toronto, Ontario, Canada (A.N.C.); Hospital Universitari Vall d'Hebron, Barcelona, Spain (V.S., J.F.P., B.G.d.B.); Hospital Clínico Universitario de Valladolid, Valladolid, Spain (I.J.A.-S., C.C.); and Hospital Clínico San Carlos de Madrid, Madrid, Spain (L.N.-F.).
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Paradis
authors.affiliation: From the Quebec Heart and Lung Institute, Laval University, Quebec, Quebec, Canada (M.U., I.J.A.-S., H.B.R., R.A., J.P., E.D., F.P., J.R.-C.); Emory University School of Medicine, Atlanta, GA (S.H., V.H.T., V.B., S.L.); St Michael's Hospital, Toronto University, Toronto, Ontario, Canada (A.N.C.); Hospital Universitari Vall d'Hebron, Barcelona, Spain (V.S., J.F.P., B.G.d.B.); Hospital Clínico Universitario de Valladolid, Valladolid, Spain (I.J.A.-S., C.C.); and Hospital Clínico San Carlos de Madrid, Madrid, Spain (L.N.-F.).
authors.forename: Eric
authors.initials: E
authors.lastname: Dumont
authors.affiliation: From the Quebec Heart and Lung Institute, Laval University, Quebec, Quebec, Canada (M.U., I.J.A.-S., H.B.R., R.A., J.P., E.D., F.P., J.R.-C.); Emory University School of Medicine, Atlanta, GA (S.H., V.H.T., V.B., S.L.); St Michael's Hospital, Toronto University, Toronto, Ontario, Canada (A.N.C.); Hospital Universitari Vall d'Hebron, Barcelona, Spain (V.S., J.F.P., B.G.d.B.); Hospital Clínico Universitario de Valladolid, Valladolid, Spain (I.J.A.-S., C.C.); and Hospital Clínico San Carlos de Madrid, Madrid, Spain (L.N.-F.).
authors.forename: Vinod H
authors.initials: VH
authors.lastname: Thourani
authors.affiliation: From the Quebec Heart and Lung Institute, Laval University, Quebec, Quebec, Canada (M.U., I.J.A.-S., H.B.R., R.A., J.P., E.D., F.P., J.R.-C.); Emory University School of Medicine, Atlanta, GA (S.H., V.H.T., V.B., S.L.); St Michael's Hospital, Toronto University, Toronto, Ontario, Canada (A.N.C.); Hospital Universitari Vall d'Hebron, Barcelona, Spain (V.S., J.F.P., B.G.d.B.); Hospital Clínico Universitario de Valladolid, Valladolid, Spain (I.J.A.-S., C.C.); and Hospital Clínico San Carlos de Madrid, Madrid, Spain (L.N.-F.).
authors.forename: Vasilis
authors.initials: V
authors.lastname: Babaliaros
authors.affiliation: From the Quebec Heart and Lung Institute, Laval University, Quebec, Quebec, Canada (M.U., I.J.A.-S., H.B.R., R.A., J.P., E.D., F.P., J.R.-C.); Emory University School of Medicine, Atlanta, GA (S.H., V.H.T., V.B., S.L.); St Michael's Hospital, Toronto University, Toronto, Ontario, Canada (A.N.C.); Hospital Universitari Vall d'Hebron, Barcelona, Spain (V.S., J.F.P., B.G.d.B.); Hospital Clínico Universitario de Valladolid, Valladolid, Spain (I.J.A.-S., C.C.); and Hospital Clínico San Carlos de Madrid, Madrid, Spain (L.N.-F.).
authors.forename: Jaume
authors.initials: J
authors.lastname: Francisco Pascual
authors.affiliation: From the Quebec Heart and Lung Institute, Laval University, Quebec, Quebec, Canada (M.U., I.J.A.-S., H.B.R., R.A., J.P., E.D., F.P., J.R.-C.); Emory University School of Medicine, Atlanta, GA (S.H., V.H.T., V.B., S.L.); St Michael's Hospital, Toronto University, Toronto, Ontario, Canada (A.N.C.); Hospital Universitari Vall d'Hebron, Barcelona, Spain (V.S., J.F.P., B.G.d.B.); Hospital Clínico Universitario de Valladolid, Valladolid, Spain (I.J.A.-S., C.C.); and Hospital Clínico San Carlos de Madrid, Madrid, Spain (L.N.-F.).
authors.forename: Carlos
authors.initials: C
authors.lastname: Cortés
authors.affiliation: From the Quebec Heart and Lung Institute, Laval University, Quebec, Quebec, Canada (M.U., I.J.A.-S., H.B.R., R.A., J.P., E.D., F.P., J.R.-C.); Emory University School of Medicine, Atlanta, GA (S.H., V.H.T., V.B., S.L.); St Michael's Hospital, Toronto University, Toronto, Ontario, Canada (A.N.C.); Hospital Universitari Vall d'Hebron, Barcelona, Spain (V.S., J.F.P., B.G.d.B.); Hospital Clínico Universitario de Valladolid, Valladolid, Spain (I.J.A.-S., C.C.); and Hospital Clínico San Carlos de Madrid, Madrid, Spain (L.N.-F.).
authors.forename: Bruno García
authors.initials: BG
authors.lastname: Del Blanco
authors.affiliation: From the Quebec Heart and Lung Institute, Laval University, Quebec, Quebec, Canada (M.U., I.J.A.-S., H.B.R., R.A., J.P., E.D., F.P., J.R.-C.); Emory University School of Medicine, Atlanta, GA (S.H., V.H.T., V.B., S.L.); St Michael's Hospital, Toronto University, Toronto, Ontario, Canada (A.N.C.); Hospital Universitari Vall d'Hebron, Barcelona, Spain (V.S., J.F.P., B.G.d.B.); Hospital Clínico Universitario de Valladolid, Valladolid, Spain (I.J.A.-S., C.C.); and Hospital Clínico San Carlos de Madrid, Madrid, Spain (L.N.-F.).
authors.forename: François
authors.initials: F
authors.lastname: Philippon
authors.affiliation: From the Quebec Heart and Lung Institute, Laval University, Quebec, Quebec, Canada (M.U., I.J.A.-S., H.B.R., R.A., J.P., E.D., F.P., J.R.-C.); Emory University School of Medicine, Atlanta, GA (S.H., V.H.T., V.B., S.L.); St Michael's Hospital, Toronto University, Toronto, Ontario, Canada (A.N.C.); Hospital Universitari Vall d'Hebron, Barcelona, Spain (V.S., J.F.P., B.G.d.B.); Hospital Clínico Universitario de Valladolid, Valladolid, Spain (I.J.A.-S., C.C.); and Hospital Clínico San Carlos de Madrid, Madrid, Spain (L.N.-F.).
authors.forename: Stamatios
authors.initials: S
authors.lastname: Lerakis
authors.affiliation: From the Quebec Heart and Lung Institute, Laval University, Quebec, Quebec, Canada (M.U., I.J.A.-S., H.B.R., R.A., J.P., E.D., F.P., J.R.-C.); Emory University School of Medicine, Atlanta, GA (S.H., V.H.T., V.B., S.L.); St Michael's Hospital, Toronto University, Toronto, Ontario, Canada (A.N.C.); Hospital Universitari Vall d'Hebron, Barcelona, Spain (V.S., J.F.P., B.G.d.B.); Hospital Clínico Universitario de Valladolid, Valladolid, Spain (I.J.A.-S., C.C.); and Hospital Clínico San Carlos de Madrid, Madrid, Spain (L.N.-F.). josep.rodes@criucpq.ulaval.ca.
authors.forename: Josep
authors.initials: J
authors.lastname: Rodés-Cabau
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery; D001145:Arrhythmias, Cardiac / Q000175:diagnosis* / Q000503:physiopathology; D032882:Comprehension; D017281:Cost of Illness; D015716:Electrocardiography, Ambulatory / Q000639:trends*; D005260:Female; D006801:Humans; D008297:Male; D011300:Preoperative Care / Q000639:trends; D012720:Severity of Illness Index; D065467:Transcatheter Aortic Valve Replacement / Q000639:trends*; D016896:Treatment Outcome
keywords: aortic valve stenosis; arrhythmia; atrial fibrillation; monitoring, ambulatory electrocardiographic; pacemaker, artificial; transcatheter aortic valve implantation