title: Prognostic value of new onset atrial fibrillation after transcatheter aortic valve implantation: A FRANCE 2 registry substudy.
abstract: BACKGROUND
  The development of new onset atrial fibrillation (NOAF) post-transcatheter aortic valve implantation (TAVI) is common and may be associated with an adverse prognosis. This study seeks to identify incidence, predictors, and impact of NOAF post-TAVI.
  
  
  METHODS
  From the multicenter study of the French national transcatheter aortic valve implantation registry, FRANCE 2, a total of 1959 patients with sinus rhythm prior to TAVI were enrolled into this study. The incidence of post-TAVI NOAF, predictors of development of NOAF and impact on 30-day and 1-year-mortalities were assessed.
  
  
  RESULTS
  Of the 1959 TAVI patients (mean-age: 82.6 ± 7.5 years, mean-logistic-EuroSCORE: 21.8 ± 14.3), 149 (7.6%) developed NOAF with the remaining 1810 (92.4%) control patients demonstrating no evidence of AF as defined by the Valve Academic Research Consortium (VARC). Advanced age and major and life-threatening bleeding were independent predictors of NOAF (95% CI: 0.93-0.99; p=0.006, 95% CI: 1.58-4.00; p<0.001, 95% CI: 1.09-3.75; p=0.025, respectively). A trend towards a higher incidence of major and life-threatening bleeding was observed in the patients undergoing TAVI via the transapical (TA)-approach compared with the transfemoral (TF)-approach. Both 30-day and cumulative 1-year-mortalities were significantly higher in patients with NOAF compared to patients without NOAF (3.0% vs. 7.4%; p=0.005, 9.1% vs. 20.8%; p<0.001, respectively). In addition, NOAF was an independent predictor of 30-day and 1-year-mortalities (HR: 2.16; 95% CI: 1.06-4.41; p=0.033, HR: 2.12; 95% CI: 1.42-3.15; p<0.001, respectively).
  
  
  CONCLUSIONS
  Advanced age and major and life-threatening bleeding were independently associated with increased incidence of NOAF, which itself was an independent predictor of 30-day and 1-year-mortalities. With regards to the various transcatheter approaches, a trend towards a higher incidence of major and life-threatening bleeding was observed only with the TA-approach.
authors.affiliation: Cardiology Department, Hôpital Henri-Mondor, Assistance-Publique-Hôpitaux-de-Paris, 51 Avenue du Maréchal de Lattre de Tassigny, 94000 Creteil, France. Electronic address: frtakr@gmail.com.
authors.forename: Akira
authors.initials: A
authors.lastname: Furuta
authors.affiliation: Cardiology Department, Hôpital Henri-Mondor, Assistance-Publique-Hôpitaux-de-Paris, 51 Avenue du Maréchal de Lattre de Tassigny, 94000 Creteil, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Lellouche
authors.affiliation: Cardiology Department, Hôpital Henri-Mondor, Assistance-Publique-Hôpitaux-de-Paris, 51 Avenue du Maréchal de Lattre de Tassigny, 94000 Creteil, France.
authors.forename: Gauthier
authors.initials: G
authors.lastname: Mouillet
authors.affiliation: Cardiology Department, Hôpital Henri-Mondor, Assistance-Publique-Hôpitaux-de-Paris, 51 Avenue du Maréchal de Lattre de Tassigny, 94000 Creteil, France.
authors.forename: Tarvinder
authors.initials: T
authors.lastname: Dhanjal
authors.affiliation: Cardiology Department, Centre-Hospitalier-Universitaire de Brest, Hôpital de la Cavale-Blanche, Boulevard Tanguy Prigent, 29609 Brest, France.
authors.forename: Martine
authors.initials: M
authors.lastname: Gilard
authors.affiliation: Cardiac Surgery Unit, Centre-Hospitalier-Universitaire de Limoges, 2 Avenue Martin Luther king, 87042 Limoges, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Laskar
authors.affiliation: Cardiology Department, Centre-Hospitalier-Universitaire de Rouen, 1 rue de Germont, Rouen, France.
authors.forename: Helene
authors.initials: H
authors.lastname: Eltchaninoff
authors.affiliation: Cardiology Department, Clinique Pasteur, Centre de recherche cardiologique, 1 rue de la petite vitesse, 31000 Toulouse, France.
authors.forename: Jean
authors.initials: J
authors.lastname: Fajadet
authors.affiliation: Cardiology Department, Centre-Hospitalier-Universitaire Xavier Bichat, Université Paris Diderot, 16 rue Henri-Huchard, 75018 Paris, France.
authors.forename: Bernard
authors.initials: B
authors.lastname: Iung
authors.affiliation: Cardiac Surgery Unit, Institut-Cardiovasculaire Paris-Sud, Massy, France.
authors.forename: Patrick
authors.initials: P
authors.lastname: Donzeau-Gouge
authors.affiliation: Cardiac Surgery Unit, Centre-Hospitalier-Universitaire Pitié salpêtrière, Université Paris, France.
authors.forename: Pascal
authors.initials: P
authors.lastname: Leprince
authors.affiliation: CHU Rennes, 2 rue Henri le Guilloux, Rennes, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Leuguerrier
authors.affiliation: Cardiac Surgery Unit, Centre-Hospitalier-Universitaire de Lille, 12 rue Jean Jaurès, Lille, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Prat
authors.affiliation: Cardiology Department, Hôpital Henri-Mondor, Assistance-Publique-Hôpitaux-de-Paris, 51 Avenue du Maréchal de Lattre de Tassigny, 94000 Creteil, France.
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Dubois-Rande
authors.affiliation: Cardiology Department, Hôpital Henri-Mondor, Assistance-Publique-Hôpitaux-de-Paris, 51 Avenue du Maréchal de Lattre de Tassigny, 94000 Creteil, France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Teiger
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D006801:Humans; D008297:Male; D009026:Mortality / Q000639:trends; D011183:Postoperative Complications / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality; D011379:Prognosis; D011446:Prospective Studies; D012042:Registries; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects* / Q000401:mortality / Q000639:trends*
keywords: Aortic stenosis; Atrial fibrillation; TAVI