Impact of Atrial Fibrillation on Outcomes in Patients Who Underwent Transcatheter Aortic Valve Replacement

• Published in: The American journal of cardiology Vol. 115; no. 2; pp. 220 - 226
• Main Authors: Maan, Abhishek, MD, Heist, E. Kevin, MD, PhD, Passeri, Jonathan, MD, Inglessis, Ignacio, MD, Baker, Joshua, MD, Ptaszek, Leon, MD, PhD, Vlahakes, Gus, MD, Ruskin, Jeremy N., MD, Palacios, Igor, MD, Sundt, Thoralf, MD, Mansour, Moussa, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 15-01-2015; Elsevier Limited
• Subjects: Aged, 80 and over; Aorta; Aortic stenosis; Aortic valve; Aortic Valve Stenosis - mortality; Aortic Valve Stenosis - surgery; Atrial Fibrillation - epidemiology; Atrial Fibrillation - etiology; Atrial Fibrillation - physiopathology; Cardiac arrhythmia; Cardiovascular; Clinical outcomes; Drug therapy; Female; Fibrillation; Follow-Up Studies; Heart attacks; Heart Valve Prosthesis; Heart valves; Hospital Mortality - trends; Hospitalization; Hospitals; Humans; Incidence; Kaplan-Meier Estimate; Length of Stay - trends; Male; Mortality; Odds Ratio; Patients; Postoperative Complications; Prognosis; Prolongation; Retrospective Studies; Risk Assessment - methods; Risk Factors; Risk groups; Transcatheter Aortic Valve Replacement - methods; Treatment Outcome
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2014.10.027

Transcatheter aortic valve replacement (TAVR) has emerged as an alternative treatment for surgical high-risk patients with severe aortic stenosis. The aim of this study was to determine the impact of atrial fibrillation (AF) on procedural outcomes. Data from 137 patients who underwent TAVR using Edwards SAPIEN valve were reviewed. The predictors of new-onset atrial fibrillation (NOAF) after the procedure were analyzed. In addition, the post-TAVR clinical outcomes and adverse events were compared according to the presence and absence of preprocedural and postprocedural AF. Previous AF was present in 49% of the patients who underwent TAVR. After the procedure, NOAF was detected in 21% of patients, and the cumulative incidence of post-TAVR AF was 60%. After TAVR, 50% of all the episodes of NOAF occurred in the initial 24 hours after the procedure. Transapical approach was observed to an important predictor of NOAF (adjusted odds ratio [OR] 5.05, 95% confidence interval [CI] 1.40 to 18.20, p = 0.013). The composite outcome of all-cause mortality, stroke, vascular complications, and repeat hospitalization in 1 month after TAVR was significantly higher in patients with previous AF (33 of 67 vs 19 of 70, adjusted OR 2.60, 95% CI 1.22 to 5.54, p = 0.013) compared with patients who did not have previous AF. The presence of post-TAVR AF led to a prolongation in the duration of intensive care unit stay by an average of 70 hours (95% CI 25 to 114.7 hours, p = 0.002). Similarly, post-TAVR AF also led to the prolongation in the hospital stay by an average of 6.7 days (95% CI 4.69 to 8.73 days, p <0.0005). In conclusion, our study demonstrates that the presence of AF before TAVR is an important predictor of the composite end point of all-cause mortality, stroke, vascular complications, and repeat hospitalization in 1 month after the procedure. AF after TAVR is more likely to be encountered with the transapical approach and is associated with a prolongation of intensive care unit and hospital stay.