Incidence, Predictive Factors, and Prognostic Value of New-Onset Atrial Fibrillation Following Transcatheter Aortic Valve Implantation
What is the clinical significance of atrial fibrillation (AF) after transcatheter aortic valve implantation (TAVI)?
TAVI (transapical in 72.5%, transfemoral in 27.5%) was performed in 138 patients (mean age 79 years) with no history of AF. New-onset AF was detected by post-procedure continuous electrocardiographic monitoring. The median duration of follow-up was 12 months.
The procedural success rate was 93.5% and the 1-month mortality rate was 7.3%. AF occurred in 32% of patients within 30 days of TAVI. Sixty-four percent of AF episodes occurred during or within 48 hours of the procedure. The only two independent predictors of AF were left atrial size and use of the transapical approach. The 1-month stroke rate was 11.4% in the AF group and 3.2% in the patients without AF. The overall rate of stroke or systemic embolism was significantly higher in the AF group than in the non-AF group (15.9% vs. 3.2%). The mortality rate during follow-up was approximately 20% and did not differ significantly between the patients with and without new-onset AF.
The authors concluded that new-onset AF occurs in approximately one-third of patients undergoing TAVI, and is associated with an increased risk of stroke and systemic embolism.
The primary mechanisms of AF after TAVI probably are adrenergic activation and myocardial injury or inflammation, particularly with the transapical approach. The heightened risk of stroke and systemic embolism during follow-up suggests that patients with new-onset AF after TAVI may be having undetected AF recurrences and should be anticoagulated for at least several months.
Keywords: Prognosis, Stroke
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