Prognostic impact of atrial fibrillation in patients undergoing transcatheter aortic valve implantation

Abstract

Background

Atrial fibrillation (AF) is the most common arrhythmia and an important risk factor for adverse cardiac outcomes, including heart failure and stroke. Moreover, AF has been linked to worse outcomes after transcatheter aortic valve implantation (TAVI). Real-world data on the impact of AF on outcomes after TAVI remain limited.

Objective

To assess the impact of AF on periprocedural and short-term outcomes after TAVI.

Methods

Patients undergoing TAVI at a tertiary center were consecutively included in a prospective registry. Cardiac rhythm at baseline was assessed using 12-lead ECGs. The primary outcome was all-cause mortality at 30 days. Secondary outcomes included all-cause mortality at 1 year, stroke at 30 days and 1 year, and procedural success, defined as freedom from periprocedural mortality, surgical re-interventions, re-interventions of the aortic valve, major access site complications, and periprocedural bleedings until discharge.

Results

Among 1655 patients undergoing TAVI, 428 patients (25.6%) had preexisting AF, and 77 patients (4.6%) were diagnosed with new-onset AF during hospitalization for TAVI. AF was not associated with higher mortality at 30 days (3.7% vs 2.0%; P = .054, adjusted hazard ratio [aHR], 1.8 [95% confidence interval (CI), 0.9–3.4]), but at 1 year (13.8% vs 8.4%; P = .001; aHR, 1.6 [95%CI, 1.2–2.2]). The stroke rate was higher in patients with AF at 30 days (5.9% vs 2.7%; P = .003; aHR, 2.1 [95%CI, 1.2–3.5]) and at 1 year (7.1% vs 3.8%; P = .005; aHR, 1.8 [95%CI, 1.2–2.9]). At discharge, 452 patients (89.5%) with AF received oral anticoagulation. After adjusting for anticoagulant therapy, the difference in stroke risk at 30 days (5.7% vs 2.3%; P = .058) and 1 year (6.8% vs 4.2%; P = .165) was no longer significant. Patients with AF experienced more major or life-threatening bleeding complications (14.2% vs 10.6%; P = .043). There were no differences in procedural success between patients with and those without AF (78.8% vs 78.3%; P = .886).

Conclusion

AF was associated with increased mortality at 1 year and higher rates of stroke and major bleeding at 30 days and 1 year after TAVI.