title: A meta-analysis of the impact of pre-existing and new-onset atrial fibrillation on clinical outcomes in patients undergoing transcatheter aortic valve implantation.
abstract: OBJECTIVE
  Little is known about the prognostic role of pre-existing atrial fibrillation (AF) and new-onset AF (NOAF) in transcatheter aortic valve implantation (TAVI). Therefore, the aim of this meta-analysis was to compare the short- and long-term clinical outcomes of patients undergoing TAVI with and without pre-existing and new-onset AF.
  
  
  RESULTS
  Twenty-six studies, enrolling 14,078 patients undergoing TAVI, of whom 33.4% had pre-existing AF and 17.5% had NOAF, were analysed for early and long-term all-cause mortality, cardiovascular mortality and cerebrovascular events (CVE). In patients with pre-existing AF, 30-day all-cause mortality was similar to patients in sinus rhythm (SR). Conversely, long-term all-cause and cardiovascular mortality were significantly greater in pre-existing AF patients than in patients with SR (20 studies; 8,743 patients; HR: 1.68; p<0.00001, and three studies; 1,138 patients; HR: 2.07; p=0.01, respectively). Pre-existing AF was not a predictor of CVE at long-term follow-up. NOAF patients showed similar short- and long-term all-cause mortality when compared to patients in SR, whereas they experienced a significantly higher incidence of CVE at short-term follow-up (six studies; 2,025 patients; HR: 2.86; p<0.00001). A non-significant increase in the incidence of CVE was observed at long-term follow-up.
  
  
  CONCLUSIONS
  Pre-existing AF is a predictor of all-cause mortality in patients undergoing TAVI. NOAF is related to the occurrence of CVE at short-term follow-up. Similarly to surgical aortic valve replacement (SAVR), the optimal management and risk stratification of these patients should be further investigated.
authors.affiliation: Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Sannino
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Gargiulo
authors.forename: Gabriele Giacomo
authors.initials: GG
authors.lastname: Schiattarella
authors.forename: Cinzia
authors.initials: C
authors.lastname: Perrino
authors.forename: Eugenio
authors.initials: E
authors.lastname: Stabile
authors.forename: Maria-Angela
authors.initials: MA
authors.lastname: Losi
authors.forename: Maurizio
authors.initials: M
authors.lastname: Galderisi
authors.forename: Raffaele
authors.initials: R
authors.lastname: Izzo
authors.forename: Giovanni
authors.initials: G
authors.lastname: de Simone
authors.forename: Bruno
authors.initials: B
authors.lastname: Trimarco
authors.forename: Giovanni
authors.initials: G
authors.lastname: Esposito
mesh_terms: D001024:Aortic Valve Stenosis / Q000453:epidemiology / Q000601:surgery*; D001281:Atrial Fibrillation / Q000453:epidemiology*; D002318:Cardiovascular Diseases / Q000401:mortality*; D002423:Cause of Death; D015897:Comorbidity; D006801:Humans; D015994:Incidence; D009026:Mortality; D011379:Prognosis; D020521:Stroke / Q000453:epidemiology*; D065467:Transcatheter Aortic Valve Replacement