title: Prevalence and Impact of Atrial Fibrillation in Patients With Severe Aortic Stenosis Undergoing Transcatheter Aortic Valve Replacement: An Analysis From the SOURCE XT Prospective Multicenter Registry.
abstract: The aims of this study were to assess the epidemiology of atrial fibrillation (AF) in patients treated with transcatheter aortic valve replacement (TAVR) and included in the large prospective SOURCE XT (SAPIEN XT Aortic Bioprosthesis Multi-Region Outcome Registry) study and to evaluate their outcomes according to the presence of pre-existing or new-onset AF (NOAF) (defined as AF occurring within 30 days after TAVR).
  
  
  
  Data on the epidemiology and clinical impact of AF in patients undergoing TAVR are scant and limited to small retrospective studies.
  
  
  
  The SOURCE XT study is a multicenter, prospective registry of consecutive patients treated with the SAPIEN XT valve at 99 sites in 17 countries. Follow-up was scheduled at discharge, 1 month, 1 year, and yearly thereafter. Patients (n = 2,706) were categorized according to the presence of pre-existing or NOAF.
  
  
  
  The prevalence of pre-existing AF was 35.6%, whereas NOAF occurred in 7.2% of patients. Both pre-existing AF and NOAF correlated with worse clinical outcomes compared with patients in sinus rhythm, including all-cause death, cardiac death, and bleeding events. NOAF was associated with higher rates of stroke at 2 years compared with sinus rhythm. Independent predictors of NOAF were age (hazard ratio: 1.1), New York Heart Association class III or IV (hazard ratio: 1.9), nontransfemoral access route (hazard ratio: 3), and balloon post-dilation (odds ratio: 1.6). No interaction was observed between any degree of post-implantation paravalvular leak and NOAF.
  
  
  
  In the large dataset of the SOURCE XT registry, the presence of either pre-existing or NOAF increased all-cause and cardiac mortality and bleeding events. NOAF was associated with increased stroke rates at long-term follow-up.
authors.affiliation: Department of Cardiac, Thoracic and Vascular Sciences, University Hospital of Padova, Padua, Italy. Electronic address: giuseppe.tarantini.1@gmail.com.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Tarantini
authors.affiliation: Department of Cardiac, Thoracic and Vascular Sciences, University Hospital of Padova, Padua, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Mojoli
authors.affiliation: Department of Cardiology, Bern University Hospital, Bern, Switzerland.
authors.forename: Stephan
authors.initials: S
authors.lastname: Windecker
authors.affiliation: King's College Hospital, London, United Kingdom.
authors.forename: Olaf
authors.initials: O
authors.lastname: Wendler
authors.affiliation: Cardiovascular Institute Paris-Sud, Massy, France.
authors.forename: Thierry
authors.initials: T
authors.lastname: Lefèvre
authors.affiliation: University Hospital Policlinic S. Orsola-Malpighi, Institute of Cardiology, Bologna, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Saia
authors.affiliation: Kerckhoff Clinic, Bad Nauheim, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Walther
authors.affiliation: Cardiology Division, Clinica Montevergine, Mercogliano, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Rubino
authors.affiliation: Centro Cardiologico Monzino, IRCCS, University of Milan, Milan, Italy.
authors.forename: Antonio L
authors.initials: AL
authors.lastname: Bartorelli
authors.affiliation: Department of Cardiac, Thoracic and Vascular Sciences, University Hospital of Padova, Padua, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Napodano
authors.affiliation: Department of Cardiac, Thoracic and Vascular Sciences, University Hospital of Padova, Padua, Italy.
authors.forename: Augusto
authors.initials: A
authors.lastname: D'Onofrio
authors.affiliation: Department of Cardiac, Thoracic and Vascular Sciences, University Hospital of Padova, Padua, Italy.
authors.forename: Gino
authors.initials: G
authors.lastname: Gerosa
authors.affiliation: Department of Cardiac, Thoracic and Vascular Sciences, University Hospital of Padova, Padua, Italy.
authors.forename: Sabino
authors.initials: S
authors.lastname: Iliceto
authors.affiliation: Cardiology Department, Hospital Bichat-Claude Bernard, Paris, France.
authors.forename: Alec
authors.initials: A
authors.lastname: Vahanian
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D063126:Balloon Valvuloplasty / Q000009:adverse effects; D001705:Bioprosthesis; D016009:Chi-Square Distribution; D005260:Female; D006350:Heart Valve Prosthesis; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D015995:Prevalence; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011474:Prosthesis Design; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D020521:Stroke / Q000453:epidemiology; D013997:Time Factors; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects* / Q000295:instrumentation / Q000401:mortality; D016896:Treatment Outcome
keywords: TAVR; atrial fibrillation; new-onset atrial fibrillation; pre-existing atrial fibrillation; stroke