Frequency of and Prognostic Significance of Atrial Fibrillation in Patients Undergoing Transcatheter Aortic Valve Implantation.
The prognostic implications of preexisting atrial fibrillation (AF) and new-onset AF (NOAF) in transcatheter aortic valve implantation (TAVI) remain uncertain. This study assesses the epidemiology of AF in patients treated with TAVI and evaluates their outcomes according to the presence of preexisting AF or NOAF. A retrospective analysis of 708 patients undergoing TAVI from 2 heart hospitals was performed. Patients were divided into 3 study groups: sinus rhythm (n = 423), preexisting AF (n = 219), and NOAF (n = 66). Primary outcomes of interest were all-cause death and stroke both at 30-day and at 1-year follow-up. Preexisting AF was present in 30.9% of our study population, whereas NOAF was observed in 9.3% of patients after TAVI. AF and NOAF patients showed a higher rate of 1-year all-cause mortality compared with patients in sinus rhythm (14.6% vs 6.5% for preexisting AF and 16.3% vs 6.5% for NOAF, p = 0.007). No differences in 30-day mortality were observed between groups. In patients with AF (either preexisting and new-onset), those discharged with single antiplatelet therapy displayed higher mortality rates at 1 year (42.9% vs 11.7%, p = 0.006). Preexisting AF remained an independent predictor of mortality at 1-year follow-up (hazard ratio [HR] 2.34, 95% CI 1.22 to 4.48, p = 0.010). Independent predictors of NOAF were transapical and transaortic approach as well as balloon postdilatation (HR 3.48, 95% CI 1.66 to 7.29, p = 0.001; HR 5.08, 95% CI 2.08 to 12.39, p <0.001; HR 2.76, 95% CI 1.25 to 6.08, p = 0.012, respectively). In conclusion, preexisting AF is common in patients undergoing TAVI and is associated with a twofold increased risk of 1-year mortality. This negative effect is most pronounced in patients discharged with single antiplatelet therapy compared with other antithrombotic regimens.
Department of Cardiology, Baylor University Medical Center, Baylor Heart and Vascular Hospital, Dallas, Texas.
Anna
A
Sannino
Department of Cardiology, Baylor University Medical Center, Baylor Heart and Vascular Hospital, Dallas, Texas.
Robert C
RC
Stoler
Department of Cardiothoracic Surgery, Baylor University Medical Center, Baylor Heart and Vascular Hospital, Dallas, Texas; Department of Cardiothoracic Surgery, The Heart Hospital Baylor Plano, Plano, Texas.
Brian
B
Lima
Department of Cardiology, The Heart Hospital Baylor Plano, Plano, Texas.
Molly
M
Szerlip
Department of Cardiothoracic Surgery, Baylor University Medical Center, Baylor Heart and Vascular Hospital, Dallas, Texas.
A Carl
AC
Henry
Department of Cardiology, Baylor University Medical Center, Baylor Heart and Vascular Hospital, Dallas, Texas.
Ravi
R
Vallabhan
Department of Cardiology, Baylor University Medical Center, Baylor Heart and Vascular Hospital, Dallas, Texas.
Robert C
RC
Kowal
Department of Cardiology, The Heart Hospital Baylor Plano, Plano, Texas.
David L
DL
Brown
Department of Cardiothoracic Surgery, The Heart Hospital Baylor Plano, Plano, Texas.
Michael J
MJ
Mack
Department of Cardiology, Baylor University Medical Center, Baylor Heart and Vascular Hospital, Dallas, Texas; Department of Cardiology, The Heart Hospital Baylor Plano, Plano, Texas. Electronic address: paul.grayburn@BSWHealth.org.
Paul A
PA
Grayburn
D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000601:surgery*; D001281:Atrial Fibrillation / Q000453:epidemiology* / Q000209:etiology; D002423:Cause of Death / Q000639:trends; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology*; D015995:Prevalence; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013781:Texas / Q000453:epidemiology; D013997:Time Factors; D065467:Transcatheter Aortic Valve Replacement