Time to new-onset atrial fibrillation after transaortic valve implantation using 14-days ambulatory electrocardiographic monitoring

Background Ambulatory long term ECG monitoring after transcatheter aortic valve implantation (TAVI) enables detection of arrhythmias that may otherwise remain underdiagnosed. While post-procedural conduction disturbances have been extensively studied, less attention has been directed toward the occurrence of atrial tachyarrhythmias after hospital discharge. Purpose The precise incidence and temporal distribution of new-onset atrial fibrillation (NOAF) during the in-hospital phase and after discharge remain insufficiently characterized. Methods Adult patients undergoing TAVI at a Swiss tertiary centre were prospectively monitored using a 14-days ambulatory ECG patch applied prior to discharge. Patients were instructed to report any cardiac symptoms using the patch-reporting-system. NOAF was defined as AF episodes ≥ 30 seconds in patients without documented AF. Results A total of 307 patients underwent 14-day ambulatory ECG monitoring after TAVI (median age 82 years [78–86], 57% male). The median analyzable monitoring time was 13.3 days [11.5–13.8]. Atrial fibrillation was detected in 82 patients (27%), of whom 15 patients (5%) had NOAF. Among patients with NOAF, 12 (80%) were diagnosed exclusively through ambulatory patch monitoring after discharge, whereas 3 patients (20%) were diagnosed during in-hospital telemetry monitoring. In those diagnosed by ambulatory monitoring, the first AF episode occurred at a median of 6 days [2–10] after initiation of monitoring. Thirteen patients (87%) had paroxysmal AF and two (13%) had persistent AF. The median AF burden was 3% [1–12]. Only five patients (33%) reported symptoms temporally associated with AF episodes. The CHA₂DS₂-VA score was ≥2 in 14 patients (93%). Detection of NOAF led to a change from antiplatelet therapy to oral anticoagulation in four patients (27%) and initiation or adjustment of antiarrhythmic therapy in seven patients (47%). Conclusions NOAF occurs in a small but clinically relevant proportion of patients undergoing TAVI, with the majority of cases remaining undetected during hospitalization. These findings underscore the importance of structured post-discharge rhythm surveillance to identify clinically actionable AF in this high-risk population.