title: Determinants and prognosis of atrial fibrillation in patients with aortic stenosis.
abstract: Atrial fibrillation (AF) is frequently encountered in patients with aortic stenosis (AS) and its incidence also increases with age. In the general population, AF is known to increase cardiovascular risk. We sought to investigate the prognostic importance of AF associated with AS in the context of routine clinical practice. This analysis was based on 809 patients (75 ± 12 years) diagnosed with AS (aortic valve area <2 cm(2)) and normal (≥50%) ejection fraction (EF). Patients were grouped according to the presence of sinus rhythm (SR) or AF at study enrollment. The AF group comprised 141 patients (17.5%) with AF, whereas 668 patients (82.5%) were in SR at inclusion. Four-year estimates of all-cause mortality with medical and surgical management were 60 ± 5% for the AF group compared with 24 ± 2% for the SR group (p = 0.0001). On multivariate analysis, the risk of all-cause mortality was higher in the AF group than in the SR group (adjusted hazard ratio [HR] 2.47 [1.83 to 3.33], p = 0.0001). AF remained associated with excess mortality risk when the analysis was limited to asymptomatic patients (adjusted HR 2.31 [1.38 to 3.89], p = 0.002) and, respectively, patients with severe AS (adjusted HR 2.22 [1.41 to 3.49], p = 0.001). Among patients managed medically, AF was independently associated with increased risk of death in the overall study population (adjusted HR 2.52 [1.81 to 3.51], p = 0.0001), in asymptomatic AS (adjusted HR 2.12 [1.19 to 3.76], p = 0.01), and in severe AS (adjusted HR 2.23 [1.30 to 3.81], p = 0.004). In conclusion, AF is a major predictor of mortality, in both medically and surgically managed patients with AS, irrespective of the functional status and the severity. AF is, therefore, a strong marker of risk in AS and should be considered for clinical decision making.
authors.affiliation: Department of Cardiology, University Hospital Amiens, Amiens, France; INSERM U-1088, Jules Verne University of Picardie, Amiens, France.
authors.forename: Franck
authors.initials: F
authors.lastname: Levy
authors.affiliation: Department of Cardiology, University Hospital Amiens, Amiens, France; Department of Cardiology, Hospital of Saint Quentin, Saint Quentin, France.
authors.forename: Dan
authors.initials: D
authors.lastname: Rusinaru
authors.affiliation: INSERM U-1088, Jules Verne University of Picardie, Amiens, France; Groupement des Hôpitaux de l'Institut Catholique de Lille/Faculté libre de médecine, Université Lille Nord de France, Lille, France.
authors.forename: Sylvestre
authors.initials: S
authors.lastname: Maréchaux
authors.affiliation: Department of Cardiology, University Hospital Amiens, Amiens, France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Charles
authors.affiliation: Department of Cardiology, University Hospital Amiens, Amiens, France.
authors.forename: Marcel
authors.initials: M
authors.lastname: Peltier
authors.affiliation: Department of Cardiology, University Hospital Amiens, Amiens, France; INSERM U-1088, Jules Verne University of Picardie, Amiens, France. Electronic address: cardiologieb.secretariat@chu-amiens.fr.
authors.forename: Christophe
authors.initials: C
authors.lastname: Tribouilloy
mesh_terms: D000368:Aged; D001024:Aortic Valve Stenosis / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D002423:Cause of Death / Q000639:trends; D015150:Echocardiography, Doppler; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D015994:Incidence; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors