title: Atrial fibrillation and aortic stenosis: impact on clinical outcomes among patients undergoing transcatheter aortic valve implantation.
abstract: BACKGROUND
  Atrial fibrillation (AF) is an important risk factor for stroke and is common among elderly patients undergoing transcatheter aortic valve implantation. The aim of this study was to assess the impact of AF on clinical outcomes among patients undergoing transcatheter aortic valve implantation.
  
  
  RESULTS
  Between August 2007 and October 2011, a total of 389 high-risk patients undergoing transcatheter aortic valve implantation were included into a prospective registry. AF was recorded in 131 patients (33.7%) with a mean CHA(2)DS(2)-VASC score of 4.5±1.2 and was paroxysmal in 26 (25.0%), persistent in 8 (7.7%), and permanent in 70 patients (67.3%). Patients with and without AF had similar baseline characteristics except for fewer revascularization procedures (coronary artery bypass grafting: 12% versus 22%; P=0.03) among AF patients. At 1 year, all-cause mortality was higher among patients with AF (30.9%) compared with those without AF (13.9%; hazard ratio [HR], 2.36; 95% confidence interval [CI], 1.43-3.90; P=0.0008). This was observed irrespective of the type of AF (permanent, HR, 2.47; 95% CI, 1.40-4.38; persistent, HR, 3.60; 95% CI, 1.10-11.78; paroxysmal, HR, 2.88; 95% CI, 1.37-6.05). Mortality gradually increased with higher CHA(2)DS(2)-VASC scores (score 1-3: HR, 2.20; 95% CI, 0.92-5.27; score 6-8: HR, 4.12; 95% CI, 2.07-8.20). The risks of stroke (3.9% versus 5.1%; HR, 0.76; 95% CI, 0.23-1.96; P=0.47) and life-threatening bleeding (19.8% versus 14.7%; HR, 1.37; 95% CI, 0.86-2.19; P=0.19) were similar among patients with and without AF.
  
  
  CONCLUSIONS
  AF is common among high-risk patients with severe aortic stenosis undergoing transcatheter aortic valve implantation and is associated with a >2-fold increased risk of all-cause and cardiovascular mortality, irrespective of the type of AF. The gradient of risk directly correlates with the CHA(2)DS(2)-VASC score.
authors: Departments of Cardiology, Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland.
authors: Stefan
authors: S
authors: Stortecky
authors: Lutz
authors: L
authors: Buellesfeld
authors: Peter
authors: P
authors: Wenaweser
authors: Dik
authors: D
authors: Heg
authors: Thomas
authors: T
authors: Pilgrim
authors: Ahmed A
authors: AA
authors: Khattab
authors: Steffen
authors: S
authors: Gloekler
authors: Christoph
authors: C
authors: Huber
authors: Fabian
authors: F
authors: Nietlispach
authors: Bernhard
authors: B
authors: Meier
authors: Peter
authors: P
authors: Jüni
authors: Stephan
authors: S
authors: Windecker
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000294:innervation / Q000473:pathology / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000150:complications / Q000401:mortality / Q000601:surgery*; D001281:Atrial Fibrillation / Q000150:complications / Q000401:mortality / Q000601:surgery*; D002404:Catheterization; D018450:Disease Progression; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000175:diagnosis; D011446:Prospective Studies; D012306:Risk; D012720:Severity of Illness Index; D020521:Stroke / Q000209:etiology; D016019:Survival Analysis; D016896:Treatment Outcome