ABSTRACT Introduction: Compliance with anticoagulation treatment for atrial fibrillation is highly variable. Smartphone electrocardiograms that allow patients to have greater insight into their arrhythmia burden may improve anticoagulant compliance. Methods: Patients were enrolled if they had atrial fibrillation with a CHA2DS2-VASc score of 2 or more, were eligible for anticoagulation and had a smartphone. Participants were randomly assigned to receive a smartphone electrocardiogram (AliveCor, Kardia) to record their electrocardiograms 5 times/week or to the control group. All patients received 6 months of anticoagulant (apixaban) dispensed as 1-month pre-loaded pill boxes. Results: A total of 100 patients were enrolled from July 2017 to August 2019, but 5 patients in the monitor arm and 1 in the control arm withdrew prematurely. The monitor and control groups did not differ in age, gender, CHA2DS2-VASc score, or comorbidities. Median medication compliance was 99.7%, with non-significantly greater compliance in the monitor group (100%) than in the control group (99.7%) (p-value=0.247). There was also no significant difference between missing any dose and use/nonuse of the smartphone monitor (48.9% vs. 55.1%; p-value=0.692). Mean monitor compliance was 86.8% ±14.0% with an average of 4.34 recorded electrocardiograms per week. Monitor group patients with perfect medication compliance had significantly higher monitor compliance than those patients who missed doses (median, 95.3% vs 86.7%; p-value=0.02). Conclusions: In a study population with higher-than-expected medication compliance, the use of smartphone electrocardiogram did not demonstrate an improvement in medication compliance as compared to usual care. Greater monitor compliance was associated with greater medication compliance.

Background: In-hospital permanent pacemaker implantation (PPMI) is a frequent and well-known complication of transcatheter aortic valve replacement (TAVR) procedure. The period of monitoring for need for pacing after discharge remains poorly understood. Methods: The National Readmission Database from first six months of calendar year 2016 and 2017 was queried for patient discharged alive after TAVR. All patients with prior pacemakers were excluded. Patients who received pacemaker after discharge (d-PPMI) were compared to a) patients receiving no pacemaker (o-PPMI) or b) patients receiving pacemaker on index admission(i-PPMI) over a 6 month follow-up. Results: Out of 39,993 patients who did not have a prior pacemaker, 4001(10.0%) underwent PPM implantation during index admission (i-PPMI) while over the next 6 months, a further 734 (1.8%) patients underwent the procedure (d-PPMI). For patients receiving PPMI during follow-up post TAVR discharge, the majority (68%) occurred within 14 days. The primary cause of readmission for d-PPMI was heart block in majority of the cases (73%; complete heart block 49%, second degree heart block 4%, bradycardia/other heart block 20%). The d-PPMI group also had a relatively shorter length of stay and a lower comorbidity burden when compared to the i-PPMI group. When compared to the o-PPMI group, the d-PPMI group were more likely to have higher advanced heart block. Conclusions: About one-fifth of pacemakers implanted post TAVR procedures happen during follow-up with a majority of them happening immediately after discharge. Risk stratification at discharge may help to identify patients who undergo PPMI post discharge.