title: Impact of atrial fibrillation on outcomes in patients who underwent transcatheter aortic valve replacement.
abstract: Transcatheter aortic valve replacement (TAVR) has emerged as an alternative treatment for surgical high-risk patients with severe aortic stenosis. The aim of this study was to determine the impact of atrial fibrillation (AF) on procedural outcomes. Data from 137 patients who underwent TAVR using Edwards SAPIEN valve were reviewed. The predictors of new-onset atrial fibrillation (NOAF) after the procedure were analyzed. In addition, the post-TAVR clinical outcomes and adverse events were compared according to the presence and absence of preprocedural and postprocedural AF. Previous AF was present in 49% of the patients who underwent TAVR. After the procedure, NOAF was detected in 21% of patients, and the cumulative incidence of post-TAVR AF was 60%. After TAVR, 50% of all the episodes of NOAF occurred in the initial 24 hours after the procedure. Transapical approach was observed to an important predictor of NOAF (adjusted odds ratio [OR] 5.05, 95% confidence interval [CI] 1.40 to 18.20, p = 0.013). The composite outcome of all-cause mortality, stroke, vascular complications, and repeat hospitalization in 1 month after TAVR was significantly higher in patients with previous AF (33 of 67 vs 19 of 70, adjusted OR 2.60, 95% CI 1.22 to 5.54, p = 0.013) compared with patients who did not have previous AF. The presence of post-TAVR AF led to a prolongation in the duration of intensive care unit stay by an average of 70 hours (95% CI 25 to 114.7 hours, p = 0.002). Similarly, post-TAVR AF also led to the prolongation in the hospital stay by an average of 6.7 days (95% CI 4.69 to 8.73 days, p <0.0005). In conclusion, our study demonstrates that the presence of AF before TAVR is an important predictor of the composite end point of all-cause mortality, stroke, vascular complications, and repeat hospitalization in 1 month after the procedure. AF after TAVR is more likely to be encountered with the transapical approach and is associated with a prolongation of intensive care unit and hospital stay.
authors.affiliation: Heart Center, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Abhishek
authors.initials: A
authors.lastname: Maan
authors.affiliation: Heart Center, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: E Kevin
authors.initials: EK
authors.lastname: Heist
authors.affiliation: Heart Center, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Passeri
authors.affiliation: Heart Center, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Ignacio
authors.initials: I
authors.lastname: Inglessis
authors.affiliation: Heart Center, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Joshua
authors.initials: J
authors.lastname: Baker
authors.affiliation: Heart Center, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Leon
authors.initials: L
authors.lastname: Ptaszek
authors.affiliation: Heart Center, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Gus
authors.initials: G
authors.lastname: Vlahakes
authors.affiliation: Heart Center, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Jeremy N
authors.initials: JN
authors.lastname: Ruskin
authors.affiliation: Heart Center, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Igor
authors.initials: I
authors.lastname: Palacios
authors.affiliation: Heart Center, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Thoralf
authors.initials: T
authors.lastname: Sundt
authors.affiliation: Heart Center, Massachusetts General Hospital, Boston, Massachusetts. Electronic address: mmansour@mgh.harvard.edu.
authors.forename: Moussa
authors.initials: M
authors.lastname: Mansour
mesh_terms: D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000401:mortality / Q000601:surgery*; D001281:Atrial Fibrillation / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D007902:Length of Stay / Q000639:trends; D008297:Male; D016017:Odds Ratio; D011183:Postoperative Complications; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D065467:Transcatheter Aortic Valve Replacement / Q000379:methods*; D016896:Treatment Outcome