In patients undergoing TAVR, the presence of valvular atrial fibrillation (AFib) increased the risk for cardiovascular death or disabling stroke compared to patients with no AFib or nonvalvular AFib, according to a study published Sept. 21 in JACC: Cardiovascular Interventions.

Taishi Okuno, MD, et al., performed a retrospective analysis of a prospective registry to assess the impact of valvular and nonvalvular AFib in patients undergoing TAVR. The primary endpoint was a composite of cardiovascular death or disabling stroke at one year after TAVR.

Of the 1,472 patients undergoing TAVR between Aug. 2007 and June 2018, 465 patients (31.6%) had AFib. AFib was categorized as nonvalvular in 376 patients (25.5%) and valvular in 89 patients (6%). AFib scores were comparable between patients with nonvalvular and valvular AFib.

Researchers found the primary endpoint occurred in 9.3% of patients with no AFib, in 14.5% of patients with nonvalvular AFib and in 24.2% of patients with valvular AFib. Results showed the rate of the composite of cardiovascular death or disabling stroke was higher in patients with valvular AFib.

"The present findings may have implications for risk stratification in patients undergoing TAVR," write the authors of the study. "Although both [AFib] and mitral stenosis are recognized to increase the risk for adverse clinical outcomes in TAVR candidates, the present study is the first to appreciate the combined effect of the [two] factors. The identification of valvular [AFib] may refine the estimated risk for adverse clinical outcomes in patients undergoing TAVR."

"[The] coexistence of [AFib] with the different presentations of valvular heart disease deserves more attention," write Bernard Iung, MD, and Vincent Algalarrondo, MD, PhD, in an accompanying editorial comment. "In addition to the obvious impact on the thromboembolic risk and the inherent indications for anticoagulant therapy, more studies are needed to ascertain the relationship between [AFib] types and aortic stenosis, thereby improving our decision-making for interventions in both diseases."

Clinical Topics: Anticoagulation Management, Arrhythmias and Clinical EP, Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, Valvular Heart Disease, Anticoagulation Management and Atrial Fibrillation, Atrial Fibrillation/Supraventricular Arrhythmias, Aortic Surgery, Cardiac Surgery and Arrhythmias, Cardiac Surgery and VHD, Interventions and Structural Heart Disease

Keywords: Atrial Fibrillation, Mitral Valve Stenosis, Retrospective Studies, Transcatheter Aortic Valve Replacement, Heart Valve Diseases, Aortic Valve Stenosis, Stroke, Anticoagulants, Registries, Risk Assessment, Decision Making

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