title: Incidence, predictive factors, and prognostic value of new-onset atrial fibrillation following transcatheter aortic valve implantation.
abstract: OBJECTIVE
  This study sought to evaluate the incidence, predictive factors, and prognostic value of new-onset atrial fibrillation (NOAF) following transcatheter aortic valve implantation (TAVI).
  
  
  BACKGROUND
  Very few data exist on the occurrence of NOAF following TAVI.
  
  
  METHODS
  A total of 138 consecutive patients with no prior history of atrial fibrillation (AF) underwent TAVI with a balloon-expandable valve. Patients were on continuous electrocardiogram monitoring until hospital discharge, and NOAF was defined as any episode of AF lasting >30 s. All clinical, echocardiographic, procedural, and follow-up data were prospectively collected.
  
  
  RESULTS
  NOAF occurred in 44 patients (31.9%) at a median time of 48 h (interquartile range: 0 to 72 h) following TAVI. The predictive factors of NOAF were left atrial (LA) size (odds ratio [OR]: 1.21 for each increase in 1 mm/m(2), 95% confidence interval [CI]: 1.09 to 1.34, p < 0.0001) and transapical approach (OR: 4.08, 95% CI: 1.35 to 12.31, p = 0.019). At 30-day follow-up, NOAF was associated with a higher rate of stroke/systemic embolism (13.6% vs. 3.2%, p = 0.021, p = 0.047 after adjustment for baseline differences between groups), with no differences in mortality rate between groups (NOAF: 9.1%, no-NOAF: 6.4%, p = 0.57). At a median follow-up of 12 months (interquartile range: 5 to 20 months), a total of 27 patients (19.6%) had died, with no differences between the NOAF (15.9%) and no-NOAF (21.3%) groups, p = 0.58. The cumulative rate of stroke and stroke/systemic embolism at follow-up were 13.6% and 15.9%, respectively, in the NOAF group versus 3.2% in the no-NOAF group (p = 0.039, adjusted p = 0.037 for stroke; p = 0.020, adjusted p = 0.023 for stroke/systemic embolism).
  
  
  CONCLUSIONS
  NOAF occurred in about one-third of the patients with no prior history of AF undergoing TAVI and its incidence was increased in patients with larger LA size and those undergoing transapical TAVI. NOAF was associated with a higher rate of stroke/systemic embolism, but not a higher mortality, at 30 days and at 1-year follow-up.
authors.affiliation: Quebec Heart & Lung Institute, Laval University, Quebec City, Canada.
authors.forename: Ignacio J
authors.initials: IJ
authors.lastname: Amat-Santos
authors.forename: Josep
authors.initials: J
authors.lastname: Rodés-Cabau
authors.forename: Marina
authors.initials: M
authors.lastname: Urena
authors.forename: Robert
authors.initials: R
authors.lastname: DeLarochellière
authors.forename: Daniel
authors.initials: D
authors.lastname: Doyle
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Bagur
authors.forename: Jacques
authors.initials: J
authors.lastname: Villeneuve
authors.forename: Mélanie
authors.initials: M
authors.lastname: Côté
authors.forename: Luis
authors.initials: L
authors.lastname: Nombela-Franco
authors.forename: François
authors.initials: F
authors.lastname: Philippon
authors.forename: Philippe
authors.initials: P
authors.lastname: Pibarot
authors.forename: Eric
authors.initials: E
authors.lastname: Dumont
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000453:epidemiology* / Q000209:etiology; D002561:Cerebrovascular Disorders / Q000453:epidemiology / Q000209:etiology; D004617:Embolism / Q000453:epidemiology / Q000209:etiology; D057510:Endovascular Procedures / Q000009:adverse effects*; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology*; D011379:Prognosis; D011792:Quebec / Q000453:epidemiology; D012307:Risk Factors