Transcatheter aortic valve replacement (TAVR) patients face a heightened risk of adverse short- and long-term outcomes if they present with preexisting atrial fibrillation (AFib) or develop new-onset AFib after the procedure, according to new data published in the Journal of Cardiovascular Medicine.[1]
“Despite its lower invasiveness compared with surgical aortic valve replacement, TAVR is not even free from complications,” wrote first author Salvatorea Arrotti, MD, with the cardiology division at the University of Modena and Reggio Emilia in Italy, and colleagues. “Preexisting AFib in patients undergoing TAVR is common, being reported in up to 51%, and new-onset AFib is frequently detected during the peri-procedural period. For this reason, AFib impact on the prognosis of patients undergoing TAVR is a remarkable topic.”
Arrotti et al. focused on real-world outcomes, tracking data from 759 patients who underwent TAVR for severe aortic stenosis from 2012 to 2022. All patients were treated at one of four facilities in Italy. The mean patient age was 82.2 years old, and 50.3% of patients were women.
Preexisting AFib before TAVR
The researchers started with an in-hospital analysis, determining that 31.8% presented with a history of AFib. These patients were more likely to have a history of prior stroke, pacemaker implantation or moderate/severe mitral regurgitation. There were no differences between patients with and without preexisting AFib when it came to age or cardiovascular risk factors such as hypertension and diabetes.
Patients with preexisting AFib faced a significantly higher risk of post-TAVR acute kidney injury (AKI) or major bleeding. There were no differences, however, in the risk of in-hospital death, stroke, vascular complications, pacemaker implantation, new-onset bundle branch block or cardiac tamponade.
When the group made additional adjustments, it confirmed that preexisting AFib was independently associated with “a higher occurrence of AKI and a trend toward a higher occurrence of major bleeding.”
New-onset AFib after TAVR
Nine patients included in the analysis died while hospitalized, leaving a cohort of 750 patients that could be included in a post-discharge analysis.
In total, 36.7% of patients were diagnosed with AFib at discharge. This included the patients who already had preexisting AFib and the 4.5% of patients who developed new-onset AFib after undergoing TAVR. After a median follow-up period of more than three years, the authors found all-cause mortality and all-cause hospitalizations were both more likely among patients with post-TAVR AFib.
A regression analysis confirmed that AFib at discharge was independently associated with an increased risk of all-cause death and all-cause hospitalization.
Reviewing the data from both the in-hospital analysis and the post-discharge analysis, the researchers found that perhaps the most noteworthy trends associated with AFib in TAVR patients were the heightened risks of AKI, all-cause mortality and hospitalization.
“It is uncertain if AFib is a cause or a marker of sicker patients, but in any case, it is a factor that should be carefully evaluated for the patient's risk stratification,” the authors wrote. “More studies are required to determine the best monitoring time range for this population.”
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Michael has more than 16 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.