New-onset atrial fibrillation after aortic valve replacement: comparison of transfemoral, transapical, transaortic, and surgical approaches.
OBJECTIVE
This study sought to determine the incidence of new-onset atrial fibrillation (AF) associated with different methods of isolated aortic valve replacement (AVR)-transfemoral (TF), transapical (TA), and transaortic (TAo) catheter-based valve replacement and conventional surgical approaches.


BACKGROUND
The relative incidences of AF associated with the various access routes for AVR have not been well characterized.


METHODS
In this single-center, retrospective cohort study, we evaluated a total of 231 consecutive patients who underwent AVR for degenerative aortic stenosis (AS) between March 2010 and September 2012. Patients with a history of paroxysmal, persistent, or chronic AF, with bicuspid aortic valves, and patients who died within 48 h after AVR were excluded. A total of 123 patients (53% of total group) qualified for inclusion. Data on documented episodes of new-onset AF, along with all clinical, echocardiographic, procedural, and 30-day follow-up data, were collated.


RESULTS
AF occurred in 52 patients (42.3%). AF incidence varied according to the procedural method. AF occurred in 60% of patients who underwent surgical AVR (SAVR), in 53% after TA-TAVR, in 33% after TAo-TAVR cases, and 14% after TF-TAVR. The episodes occurred at a median time interval of 53 (25th to 75th percentile, 41 to 87) h after completion of the procedure. Procedures without pericardiotomy had an 82% risk reduction of AF compared with those with pericardiotomy (adjusted odds ratio: 0.18; 95% confidence interval: 0.05 to 0.59).


CONCLUSIONS
AF was a common complication of AVR with a cumulative incidence of >40% in elderly patients with degenerative AS who underwent either SAVR or TAVR. AF was most common with SAVR and least common with TF-TAVR. Procedures without pericardiotomy were associated with a lower incidence of AF.
Cardiovascular Division, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida.
Tanyanan
T
Tanawuttiwat
Temple Heart and Vascular Center, Temple University, Philadelphia, Pennsylvania (formerly at Cardiovascular Division, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida).
Brian P
BP
O'Neill
Cardiovascular Division, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida.
Mauricio G
MG
Cohen
Department of Obstetrics and Gynecology, Chiang Mai University, Chiang Mai, Thailand.
Orawee
O
Chinthakanan
Cardiovascular Division, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida.
Alan W
AW
Heldman
Cardiovascular Division, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida.
Claudia A
CA
Martinez
Cardiovascular Division, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida.
Carlos E
CE
Alfonso
Cardiovascular Division, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida.
Raul D
RD
Mitrani
Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida.
Conrad J
CJ
Macon
Cardiothoracic Surgery, Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida.
Roger G
RG
Carrillo
Cardiothoracic Surgery, Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida.
Donald B
DB
Williams
Center of Structural Heart Disease, Henry Ford Hospital and Medical Group, Detroit, Michigan.
William W
WW
O'Neill
Cardiovascular Division, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida. Electronic address: rmyerbur@med.miami.edu.
Robert J
RJ
Myerburg
D000369:Aged, 80 and over; D001013:Aorta, Thoracic; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000601:surgery*; D001281:Atrial Fibrillation / Q000453:epidemiology* / Q000209:etiology; D006328:Cardiac Catheterization / Q000009:adverse effects* / Q000379:methods; D016001:Confidence Intervals; D004452:Echocardiography; D005260:Female; D005263:Femoral Artery; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D015994:Incidence; D008297:Male; D016017:Odds Ratio; D011183:Postoperative Complications; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
atrial fibrillation; transcatheter aortic valve replacement