Ambulatory Smartwatch ECG Monitoring among Patients Undergoing Transcatheter Aortic Valve Replacement Early after Discharge: An Observational Study

Background: As an emerging arrhythmia monitor, ambulatory smartwatch electrocardiogram (ECG) provides an option for home-based monitoring of delayed new-onset arrhythmic events after transcatheter aortic valve replacement (TAVR). We aimed to validate the diagnostic efficacy of a consumer smartwatch ECG in TAVR recipients, while further explore the occurrence rate of both tachy- and brady-arrhythmia for 30 days after discharge to support risk management. Methods: Consecutive TAVR recipients from February 26th, 2021 to December 13th, 2021 were enrolled prospectively, receiving simultaneous 24-hour Holter and 12-lead ECG compared with smartwatch ECG during hospitalization and daily smartwatch ECG collection for 30 days after discharge. Results: Among 110 patients, the efficacy of smartwatch ECG presented sensitivity and specificity in diagnosing atrial fibrillation (AF) as 1.00 and 0.97, left bundle branch block (LBBB) as 0.61 and 0.88, and right bundle branch block (RBBB) as 0.60 and 0.97, respectively, compared with 24-hour Holter, presented sensitivity and specificity in diagnosing AF as 0.88 and 1.00, LBBB as 0.90 and 0.96, and RBBB as 0.83 and 0.94, respectively, compared with 12-lead ECG. At 30-day follow-up, new-onset arrhythmia included new-onset severe conduction disturbance (SCD) (23.6%), new-onset AF (21.8%), new-onset permanent LBBB (14.5%) and new-onset permanent RBBB (0.9%), 69.2% (36/52) of early new-onset LBBB recovered at 30-day follow-up. Conclusions: The diagnostic efficacy of consumer smartwatch ECG in arrhythmic events among TAVR population was acceptable, which provided a recommendable option for home-based management. Clinical Trial Registration: “Continuously ambulatory rhythm monitoring and predictors of electrocardio-related adverse events in 30 days after transcatheter aortic valve replacement”, Identifier: ChiCTR2000041244, http://www.chictr.org.cn/showproj.aspx?proj=66324.