Prediction of New-Onset Atrial Fibrillation in Transcatheter Aortic Valve Implantation

• Published in: Acta Cardiologica Sinica Vol. 40; no. 4; pp. 437 - 444
• Main Authors: Karakulak, Ugur Nadir, Sahiner, Levent, Kaya, Ergun Baris, Sener, Yusuf Ziya, Ates, Ahmet Hakan, Aytemir, Kudret, Ozer, Necla
• Format: Journal Article
• Language: English
• Published: China (Republic : 1949- ) 中華民國心臟學會 01-07-2024; Taiwan Society of Cardiology
• Subjects: Original; Valvular Disease; Total atrial conduction time; Transcatheter aortic valve implantation; Tissue Doppler imaging; Atrial fibrillation
• ISSN: 1011-6842
• DOI: 10.6515/ACS.202407_40(4).20240201A

Background: This study investigates the association between prolonged total atrial conduction time and the development of new-onset atrial fibrillation (AF) following transcatheter aortic valve implantation (TAVI). Methods: We enrolled 307 patients who underwent TAVI. Total atrial conduction time was calculated as the time between the onset of the P wave on the electrocardiography and the peak of the a' wave velocity (PA-TDI duration) on tissue Doppler imaging echocardiography. Results: A total of 263 patients were analyzed after excluding 44 with pre-existing AF. Of these 263 patients, 47 (17.8%) experienced new-onset AF after the TAVI procedure. The new-onset AF group had an older median age (80.6 vs. 77.5 years) and a higher incidence of paravalvular aortic regurgitation than those without AF (none 29.8%, mild 46.8%,moderate 23.4%). The new-onset AF group had increased end-systolic diameter (35.0 vs. 31.7 mm, p = 0.03), left atrial diameter (44.7 vs. 41.9 mm, p = 0.049), and PA-TDI duration (137.0 vs. 125.4 ms, p = 0.009). Older age, the presence of paravalvular aortic regurgitation, and prolonged PA-TDI duration were independently associated with new-onset AF in multivariate analysis. The optimal cut-off value for PA-TDI duration was 123.5 ms. Conclusions: AF in patients treated with TAVI may pose significant risks for morbidity and mortality. PA-TDI duration, a readily available echocardiographic parameter, can detect patients with a high risk of new-onset AF.