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Atrial Fibrillation and Transcatheter Aortic Valve Implantation
Study Questions:
What are the baseline characteristics and clinical outcomes of patients with pre-existing atrial fibrillation (AF), and of patients who presented with new-onset AF after transcatheter aortic valve implantation (TAVI)?
Methods:
The FRANCE-2 registry included all patients undergoing TAVI (n = 3,933) in France in 2010 and 2011. New-onset AF was defined as the occurrence of AF post-procedure in a patient with no documented history of AF. The investigators compared 30-day and 1-year VARC 2–defined clinical outcomes: 1) between patients with pre-existing AF versus those without, and 2) between patients with persistent sinus rhythm versus patients with new-onset AF after TAVI. Outcome analyses were adjusted for baseline and procedural characteristics using multivariate logistic regression analysis or a Cox model.
Results:
AF was documented before TAVI in 25.8% of patients. New-onset AF was observed in 174 patients after TAVI among patients without a history of pre-existing AF (6.0%). At 1 year, the rates all-cause death (26.5 vs. 16.6%, respectively; p < 0.001) and cardiovascular death (11.5 vs. 7.8%, respectively; p < 0.001) were significantly higher in patients with pre-existing AF compared with those without AF. Rehospitalization for worsening heart failure and New York Heart Association functional class was also higher in patients with pre-existing AF versus those without, resulting in a higher rate of combined efficacy endpoint in this group (p < 0.001). A history of stroke, surgical (nontransfemoral) approach, cardiological, and hemorrhagic procedure-related events were all independently related to the occurrence of new-onset post-procedural AF. New-onset AF in patients without pre-existing AF was associated with a higher rate of combined safety endpoint at 30 days (p < 0.001), and a higher rate of both all-cause death and combined efficacy endpoint at 1 year (p = 0.003 and p = 0.02, respectively).
Conclusions:
The authors concluded that pre-existing and new-onset AF are both associated with higher mortality and morbidity after TAVI.
Perspective:
This prospective registry reports that both pre-existing and new-onset AF were associated with higher mortality and morbidity at 1 year. The higher rate of death observed in pre-existing AF patients seems to be linked to heart failure, whereas the poorer outcome in patients in whom new-onset AF developed after TAVI could be related to the procedure. Pre-existing AF should be taken into account for future risk scores dedicated to selection of patients for either TAVI or surgical aortic valve replacement, and specific post-procedural management may be indicated for patients in whom new-onset AF develops after TAVI.
Keywords: Arrhythmias, Cardiac, Atrial Fibrillation, Cardiac Surgical Procedures, Heart Failure, Heart Valve Prosthesis Implantation, Hemorrhage, Stroke, Transcatheter Aortic Valve Replacement
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