Patients who develop atrial fibrillation (AFib) after undergoing TAVR may be at higher risk of death, stroke and myocardial infraction (MI), compared with those who have pre-existing AFib, according to a study published Sept. 3 in JACC: Cardiovascular Interventions.

Amit N. Vora, MD, MPH, et al., linked data from the STS/ACC TVT Registry with outcomes data from the Centers for Medicare and Medicaid Services to establish rates of new-onset AFib in TAVR patients and to evaluate their management and outcomes. The researchers analyzed records of 13,356 patients who underwent TAVR at 381 sites. More than half of all TAVR patients experienced AFib, either before or after the procedure, with 1,138 patients (8.4 percent) developing AFib after TAVR.

Patients developing AFib were older, more likely to be female, had higher Society of Thoracic Surgeons risk scores, and were often treated using non-transfemoral access. The incidence of AFib was 4.4 percent among transfemoral-access patients and 16.5 percent among transapical-access patients.

Patients with new-onset AFib, vs. those who did not, had higher rates of in-hospital mortality (7.8 vs. 3.4 percent; p<0.01) and stroke (4.7 vs. 2.0 percent; p<0.01). In addition, the adjusted analysis showed that after one year, patients with new-onset AFib had a 37 percent higher risk of death, 50 percent higher risk of stroke and 24 percent higher risk of bleeding.

Only 28.9 percent of new-onset AFib patients were discharged on oral anticoagulation, despite having a median CHA2DS2-VASc score of 5.

According to the researchers, current guidelines for treating patients at high risk of stroke and bleeding are unclear, and additional research is needed to determine the best treatment strategy.

Keywords: Atrial Fibrillation, Transcatheter Aortic Valve Replacement, Stroke, Registries, National Cardiovascular Data Registries, STS/ACC TVT Registry

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