Patients with new-onset AFib at greatest risk for complications after TAVR
Cardiac patients who develop new-onset atrial fibrillation (AFib) after transcatheter aortic valve replacement (TAVR) are at a higher risk for complications like stroke, myocardial infarction and death than those whose AFib was established before the procedure, researchers report in the current online issue of JACC: Cardiovascular Interventions.
First author Amit N. Vora, MD, MPH, an interventional cardiologist and researcher from Duke University Medical Center and the Duke Clinical Research Institute, and colleagues said in the journal that rhythm disorders—including AFib—tend to complicate TAVR. In clinical trials, patients with AFib have historically seen worse outcomes following TAVR than those without an arrhythmia.
“Current guidelines are murky regarding the optimal treatment strategy for these patients, who often tend to be at high risk for stroke but also high risk for bleeding,” Vora said in a release from the American College of Cardiology.
Vora’s team pulled data for their study from the STS/ACC TVT Registry, which is linked to outcomes data from CMS. Of 13,356 patients undergoing TAVR at 381 sites across the U.S., 1,138 developed AFib after their procedure.
“We found that about 8 percent of patients undergoing TAVR that did not have pre-existing AFib developed new-onset AFib after their procedure,” Vora said. “When you combine patients that had AFib prior to the TAVR procedure and those that develop it after, more than one-half of all patients undergoing TAVR have to also deal with co-existing AFib.”
Rates of in-hospital mortality, stroke and heart attack were all higher among new-onset AFib patients, she said. Those with a recent diagnosis were also more likely to be older, female and have severe chronic obstructive pulmonary disease, and were at a 37 percent increased risk for death during the year following their procedure.
Vora et al. wrote additional research is necessary before cardiologists can come to a consensus as to what the best management guidelines for TAVR patients with, or at a high risk for, arrhythmias might be.
“Although there are a number of trials that are examining various strategies for this population, we need to continue to look very closely at this and determine the best care management for these high-risk patients,” Vora said.
After graduating from Indiana University-Bloomington with a bachelor’s in journalism, Anicka joined TriMed’s Chicago team in 2017 covering cardiology. Close to her heart is long-form journalism, Pilot G-2 pens, dark chocolate and her dog Harper Lee.