title: Temporal changes of new-onset atrial fibrillation in patients randomized to surgical or transcatheter aortic valve replacement.
abstract: BACKGROUND
  Temporal development of new-onset atrial fibrillation (NOAF) after aortic valve replacement is unclear, and opportunistic screening has limited diagnostic accuracy. This is the first study to investigate the incidence and temporal development of NOAF detected by implantable loop recorder (ILR) in patients with aortic stenosis, randomized to surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR).
  
  
  METHODS
  An ILR was implanted in a subgroup of patients without pre-procedural atrial fibrillation (AF), randomized to SAVR or TAVR in the NOTION trial. Data from the ILR were transmitted in intervals of 2weeks for 12weeks post-procedurally and analyzed.
  
  
  RESULTS
  The study included 25 and 27 patients who underwent SAVR and TAVR, respectively. The cumulative rate of NOAF was 100% and 81.5% for patients undergoing SAVR and TAVR, respectively (P=0.06). TAVR patients without NOAF 6weeks post-procedurally remained free from NOAF. The prevalence of AF after SAVR decreased significantly after 8weeks when compared with the first 2weeks (50.0% vs. 84.0%, respectively; P<0.05). The prevalence of AF after TAVR did not change significantly during follow-up. The median AF burden (percentage of time with AF) was 2.8% and 0.04% during the first 2weeks after SAVR and TAVR, respectively (P=0.01) and it decreased significantly over time after SAVR but not after TAVR.
  
  
  CONCLUSIONS
  NOAF subsided 6weeks after TAVR. AF prevalence and burden decreased significantly over time after SAVR, but remained stable after TAVR. These findings may be considered for post-procedural anti-coagulation strategy.
authors.affiliation: Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, 2100 Copenhagen, Denmark. Electronic address: troels.hoejsgaard.jorgensen@regionh.dk.
authors.forename: Troels Højsgaard
authors.initials: TH
authors.lastname: Jørgensen
authors.affiliation: Department of Cardiothoracic Surgery, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, 2100 Copenhagen, Denmark.
authors.forename: Hans Gustav Hørsted
authors.initials: HG
authors.lastname: Thyregod
authors.affiliation: Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, 2100 Copenhagen, Denmark.
authors.forename: Julie Bjerre
authors.initials: JB
authors.lastname: Tarp
authors.affiliation: Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, 2100 Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, 2100 Copenhagen, Denmark; Danish Arrhythmia Research Centre, University of Copenhagen, 2100 Copenhagen, Denmark.
authors.forename: Jesper Hastrup
authors.initials: JH
authors.lastname: Svendsen
authors.affiliation: Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, 2100 Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, 2100 Copenhagen, Denmark.
authors.forename: Lars
authors.initials: L
authors.lastname: Søndergaard
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000601:surgery; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000209:etiology; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology; D015995:Prevalence; D012307:Risk Factors; D012720:Severity of Illness Index; D013223:Statistics as Topic; D013997:Time Factors; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects / Q000379:methods; D016896:Treatment Outcome
keywords: Atrial fibrillation; Implantable loop recorder; Surgical aortic valve replacement; Transcatheter aortic valve replacement