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Systematic Ambulatory ECG Monitoring Following TAVI (RECORDII)

Systematic Ambulatory ECG Monitoring Following TAVI: A Prospective Randomized Trial.

This multicenter, prospective, randomized superiority trial will evaluate whether systematic 14-day ambulatory ECG monitoring following hospital discharge after transcatheter aortic valve implantation (TAVI) reduces the risk of sudden death, symptomatic arrhythmic events, or stroke within 1 year compared with standard post-discharge care. Patients undergoing successful TAVI without permanent pacemaker implantation and presenting with at least one ECG conduction abnormality at hospital discharge will be randomized to receive either ambulatory ECG monitoring or standard follow-up. All participants will undergo routine clinical follow-up at 30 days and 1 year after TAVI.

Aperçu de l'étude

Statut

Pas encore de recrutement

Intervention / Traitement

Description détaillée

Transcatheter aortic valve implantation (TAVI) is an established treatment for severe aortic stenosis. Despite advances in transcatheter heart valve technology and procedural techniques, conduction disturbances remain among the most frequent complications following TAVI. High-grade atrioventricular block, complete heart block, and new-onset bundle branch block may occur after the procedure and can lead to delayed permanent pacemaker implantation or life-threatening arrhythmic events. The increasing adoption of minimalist TAVI pathways with hospital discharge within 24-72 hours raises concerns that clinically significant arrhythmias may develop after discharge and remain undetected.

Ambulatory electrocardiographic (ECG) monitoring provides continuous rhythm surveillance during daily activities and enables the early detection of both symptomatic and asymptomatic bradyarrhythmias and tachyarrhythmias. Previous observational studies have demonstrated that clinically significant bradyarrhythmias occur in approximately 5-10% of patients during the first weeks after TAVI, particularly among those with baseline or new-onset conduction abnormalities. Ambulatory ECG monitoring has also identified previously unrecognized atrial fibrillation, allowing timely initiation of anticoagulation therapy in patients at high risk of thromboembolic events.

Although several prospective studies have evaluated ambulatory ECG monitoring after TAVI, most have been observational and were designed primarily to describe the incidence of post-procedural arrhythmias rather than to assess their impact on clinical outcomes. Preliminary evidence from the RECORD pilot study suggested that systematic ambulatory ECG monitoring after hospital discharge was associated with earlier identification and treatment of clinically significant arrhythmias and a reduction in the composite of sudden death, symptomatic arrhythmic events, and stroke during 1-year follow-up, with the greatest benefit observed among patients with conduction abnormalities at hospital discharge.

This randomized trial has been designed to provide definitive evidence regarding the clinical value of systematic ambulatory ECG monitoring after TAVI in patients at increased risk of post-procedural conduction disturbances. The study will evaluate whether early detection and management of clinically significant arrhythmias can improve clinical outcomes during the year following the procedure.

Type d'étude

Interventionnel

Inscription (Estimé)

754

Phase

  • N'est pas applicable

Contacts et emplacements

Cette section fournit les coordonnées de ceux qui mènent l'étude et des informations sur le lieu où cette étude est menée.

Coordonnées de l'étude

Sauvegarde des contacts de l'étude

Lieux d'étude

    • Quebec
      • Québec, Quebec, Canada, G1Y 4G5
        • Institut universitaire de cardiologie et de pneumologie de Québec - UL
        • Contact:
        • Chercheur principal:
          • Josep Rodés-Cabau, MD, PhD
        • Sous-enquêteur:
          • Francois Philippon, MD

Critères de participation

Les chercheurs recherchent des personnes qui correspondent à une certaine description, appelée critères d'éligibilité. Certains exemples de ces critères sont l'état de santé général d'une personne ou des traitements antérieurs.

Critère d'éligibilité

Âges éligibles pour étudier

  • Adulte
  • Adulte plus âgé

Accepte les volontaires sains

Non

La description

Inclusion Criteria:

  • Age >18 years
  • Successful TAVI procedure.
  • Hospitalization discharge ≤72 hrs following the TAVI procedure.
  • Presence of at least 1 ECG abnormality at hospital discharge (QRS ≥120 ms OR PR ≥200 ms)

Exclusion Criteria:

  • Pacemaker implantation (pre- TAVI or during hospitalization after the procedure).
  • TAVI valve-in-valve procedure
  • Any complication or logistic reason precluding hospital discharge ≤72 hrs following the TAVI procedure.
  • Impossibility to obtain signed informed consent.

Plan d'étude

Cette section fournit des détails sur le plan d'étude, y compris la façon dont l'étude est conçue et ce que l'étude mesure.

Comment l'étude est-elle conçue ?

Détails de conception

  • Objectif principal: Traitement
  • Répartition: Randomisé
  • Modèle interventionnel: Affectation parallèle
  • Masquage: Aucun (étiquette ouverte)

Armes et Interventions

Groupe de participants / Bras
Intervention / Traitement
Expérimental: Ambulatory ECG monitoring
Participants will undergo ambulatory ECG monitoring at hospital discharge following TAVI. Continuous ECG monitoring will be performed for 14 days using an ambulatory ECG monitoring device. Clinically significant bradyarrhythmias or tachyarrhythmias detected during monitoring will be reviewed and managed according to clinical practice, including appropriate therapeutic interventions when indicated.
Participants randomized to the intervention arm will undergo systematic ambulatory ECG monitoring at hospital discharge following the TAVI procedure. A wearable ambulatory ECG monitoring device will be applied for continuous rhythm monitoring during a 14-day period. The device will allow detection of clinically significant bradyarrhythmias and tachyarrhythmias. Detected arrhythmic events will be reviewed by the study team, and appropriate clinical management, including further evaluation or therapeutic intervention, will be performed according to the nature of the detected abnormality and standard clinical practice.
Aucune intervention: Standard care (no ambulatory ECG monitoring device).
Participants will receive standard post-TAVI care without systematic ambulatory ECG monitoring at hospital discharge. Clinical follow-up will be performed according to routine practice.

Que mesure l'étude ?

Principaux critères de jugement

Mesure des résultats
Description de la mesure
Délai
Rate of the combined endpoint (sudden death, symptomatic arrhythmias or stroke)
Délai: Within the year following the TAVI procedure
Composite endpoint including sudden death, symptomatic arrhythmias, or stroke.
Within the year following the TAVI procedure

Mesures de résultats secondaires

Mesure des résultats
Description de la mesure
Délai
Incidence of sudden death
Délai: 1 year after TAVI
Sudden death
1 year after TAVI
Incidence of symptomatic arrhythmias
Délai: 1 year after TAVI
All symptomatic arrhythmias events
1 year after TAVI
Incidence of stroke
Délai: 1 year after TAVI
All stroke events
1 year after TAVI
Incidence of PPI
Délai: 30 days after TAVI
Number of patients with PPI
30 days after TAVI
Incidence of PPI
Délai: 1 year after TAVI
Number of patients with PPI
1 year after TAVI
Incidence of the combined endpoint (sudden death, symptomatic arrhythmias or stroke) at 30 days
Délai: 30 days after TAVI
Composite endpoint including sudden death, symptomatic arrhythmias, or stroke.
30 days after TAVI
Incidence of sudden death
Délai: 30 days after TAVI
Sudden death
30 days after TAVI
Incidence of symptomatic arrhytmias
Délai: 30 days after TAVI
All symptomatic arrhythmias events
30 days after TAVI
Incidence of stroke
Délai: 30 days after TAVI
All stroke events
30 days after TAVI
Incidence of the combined endpoint (sudden death, symptomatic arrhythmias, stroke) according to patient sex
Délai: 1 year after TAVI
Composite endpoint including sudden death, symptomatic arrhythmias, or stroke, analyzed according to patient sex.
1 year after TAVI
Incidence of the combined endpoint of sudden death, symptomatic arrhythmias, or stroke) according to ECG abnormalities
Délai: 1 year after TAVI
Composite endpoint including sudden death, symptomatic arrhythmias, or stroke, analyzed according to ECG abnormality status (pre-existing versus new-onset after TAVI).
1 year after TAVI
Incidence of the combined endpoint according to baseline ECG abnormality type
Délai: 1 year after TAVI
Composite endpoint (sudden death, symptomatic arrhythmias, or stroke) analyzed according to the type of ECG abnormality present before TAVI.
1 year after TAVI
Incidence of sudden death according to baseline ECG abnormality type
Délai: 1 year after TAVI
Sudden death analyzed according to the type of ECG abnormality present before TAVI.
1 year after TAVI
Incidence of symptomatic arrhythmias according to baseline ECG abnormality type
Délai: 1 year after TAVI
Symptomatic arrhythmias according to the type of ECG abnormality present before TAVI.
1 year after TAVI
Incidence of stroke according to baseline ECG abnormality type
Délai: 1 year after TAVI
Stroke according to the type of ECG abnormality present before TAVI.
1 year after TAVI
Incidence of the combined endpoint according to discharge ECG abnormality type
Délai: 1 year after TAVI
Composite endpoint (sudden death, symptomatic arrhythmias, or stroke) according to the type of ECG abnormality present at hospital discharge.
1 year after TAVI
Incidence of sudden death according to discharge ECG abnormality type
Délai: 1 year after TAVI
Sudden death according to the type of ECG abnormality present at hospital discharge.
1 year after TAVI
Incidence of symptomatic arrhythmias according to discharge ECG abnormality type
Délai: 1 year after TAVI
Symptomatic arrhythmias according to the type of ECG abnormality present at hospital discharge.
1 year after TAVI
Incidence of stroke according to discharge ECG abnormality type
Délai: 1 year after TAVI
Stroke according to the type of ECG abnormality present at hospital discharge.
1 year after TAVI
Change in quality of life
Délai: Baseline to 1 year after TAVI
Quality of life assessed using the EQ-5D-5L questionnaire.
Baseline to 1 year after TAVI
Percentage of ventricular pacing
Délai: 1 year after TAVI
Ventricular pacing burden in participants with permanent pacemakers.
1 year after TAVI
Incidence of all-cause mortality
Délai: 30 days after TAVI
All-cause mortality
30 days after TAVI
Incidence of cardiovascular mortality
Délai: 30 days after TAVI
Cardiovascular mortality
30 days after TAVI
Incidence of all-cause mortality
Délai: 1 year after TAVI
All cause mortality
1 year after TAVI
Incidence of cardiovasculare mortality
Délai: 1 year after TAVI
Cardiovascular mortality
1 year after TAVI

Collaborateurs et enquêteurs

C'est ici que vous trouverez les personnes et les organisations impliquées dans cette étude.

Les enquêteurs

  • Chercheur principal: Josep Rodes-Cabau, MSc, Fondation IUCPQ

Publications et liens utiles

La personne responsable de la saisie des informations sur l'étude fournit volontairement ces publications. Il peut s'agir de tout ce qui concerne l'étude.

Publications générales

Dates d'enregistrement des études

Ces dates suivent la progression des dossiers d'étude et des soumissions de résultats sommaires à ClinicalTrials.gov. Les dossiers d'étude et les résultats rapportés sont examinés par la Bibliothèque nationale de médecine (NLM) pour s'assurer qu'ils répondent à des normes de contrôle de qualité spécifiques avant d'être publiés sur le site Web public.

Dates principales de l'étude

Début de l'étude (Estimé)

1 août 2026

Achèvement primaire (Estimé)

1 décembre 2028

Achèvement de l'étude (Estimé)

1 décembre 2028

Dates d'inscription aux études

Première soumission

21 juillet 2026

Première soumission répondant aux critères de contrôle qualité

27 juillet 2026

Première publication (Réel)

31 juillet 2026

Mises à jour des dossiers d'étude

Dernière mise à jour publiée (Réel)

31 juillet 2026

Dernière mise à jour soumise répondant aux critères de contrôle qualité

27 juillet 2026

Dernière vérification

1 juillet 2026

Plus d'information

Termes liés à cette étude

Plan pour les données individuelles des participants (IPD)

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INDÉCIS

Description du régime IPD

A decision regarding IPD sharing has not yet been made. Following study completion, requests for access to de-identified individual participant data may be considered by the sponsor on a case-by-case basis, subject to ethical, legal, and institutional requirements.

Informations sur les médicaments et les dispositifs, documents d'étude

Étudie un produit pharmaceutique réglementé par la FDA américaine

Non

Étudie un produit d'appareil réglementé par la FDA américaine

Non

Ces informations ont été extraites directement du site Web clinicaltrials.gov sans aucune modification. Si vous avez des demandes de modification, de suppression ou de mise à jour des détails de votre étude, veuillez contacter register@clinicaltrials.gov. Dès qu'un changement est mis en œuvre sur clinicaltrials.gov, il sera également mis à jour automatiquement sur notre site Web .

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