Ambulatory monitoring to detect hemodynamic and electrical impact of severe tricuspid valve regurgitation: a pilot study

Tricuspid valve regurgitation (TVR) is associated with adverse clinical outcomes, while optimal treatment strategies and patient selection remain uncertain. Identifying early signs of hemodynamic compromise is challenging. This study explores whether 14-day ambulatory electrocardiographic (ECG) monitoring can correlate with echocardiographic markers of right ventricular (RV) dysfunction in patients with severe TVR. In this pilot study, 20 patients with echocardiographically confirmed severe (≥ 3/4) TVR underwent 14-day Byteflies® Holter monitoring. Electrocardiographic parameters were compared to echocardiographic indices of RV function and TVR severity. Monitoring was feasible, with a median analysable ECG data yield of 88.3% (IQR 82.5–94.2%). New arrhythmic findings led to therapeutic changes in a small subset. In exploratory analyses, compared with participants without nsVT, those with nsVT had lower TAPSE (median difference − 4.70 mm; 95% CI − 7.05 to − 0.80) and lower LVEF (median difference − 5.25%, 95% CI − 24.0 to − 0.5). TAPSE showed an inverse association with median heart rate (ρ − 0.553; 95% CI − 0.841 to − 0.155) and with VT burden (ρ − 0.454; 95% CI − 0.720 to − 0.080), and a positive association with supraventricular runs (ρ 0.567; 95% CI 0.174–0.815). Fourteen-day ambulatory ECG monitoring was feasible and acceptable in severe TVR, with high data yield and preliminary signals of association between rhythm metrics and echocardiographic markers of RV function. These exploratory findings are hypothesis-generating and require confirmation in larger, adequately powered studies. ClinicalTrials.gov, NCT07043465. Registered June 11, 2025—retrospectively registered.