How persistent AFib impacts TAVR survival
Patients with persistent atrial fibrillation (AFib) who undergo transcatheter aortic valve replacement (TAVR) may face a heightened risk of long-term mortality, according to new findings published in the American Journal of Cardiology.[1] However, this does not appear to be the case when patients present with preoperative paroxysmal AFib.
The study’s authors focused on data from nearly 3,000 TAVR patients treated at a single high-volume medical center in the United States. A total of 38% of patients included in the analysis had with a history of AFib at the time of treatment. While approximately half of those patients presented with paroxysmal AFib—meaning it was spontaneous and could be controlled with treatment—the other half presented with persistent AFib that “failed to terminate within seven days.”
After one year, AFib patients were associated with higher rates of all-cause mortality (9.0% vs. 6.1%) and hospital readmission (13.1% vs. 8.8%) than those with no history of AFib. AFib patients also had significantly lower Kansas City Cardiomyopathy Questionnaire (KCCQ) Scores. However, there were not significant differences in all-cause mortality, hospital readmission or KCCQ score between patients with persistent AFib and those with paroxysmal AFib after one year.
After a mean follow-up period of more than four years, the group noted, these trends appeared to change: preoperative paroxysmal AFib was no longer associated with an increased risk of all-cause mortality. Preoperative persistent AFib, meanwhile, was still linked to a greater mortality risk.
“A possible explanation of our findings is that persistent AFib is a marker for more advanced aortic stenosis with increased structural changes of the atrial wall,” wrote first author Ritika Kompella, MD, a resident with the University of Connecticut, and colleagues. “Notably, there is significant overlap in the risk factors between AFib and aortic stenosis including advanced age, hypertension and ischemic heart disease. The pathophysiology of their connection involves left ventricular remodeling and elevated end-diastolic pressures as a result of aortic stenosis, precipitating elevated left atrial pressures, left atrial dilation and eventual left atrial fibrosis.”
Kompella et al. emphasized that care teams may want to pay close attention to any observed differences in left atrial volume index (LAVI) when reviewing follow-up echocardiography results. For example, severe left atrial enlargement in patients with persistent AFib may suggest they face a lower risk of long-term survival.
“Diagnostic testing to define LAVI may be considered in patients with preexisting AFib being evaluated for TAVR to further define prognosis,” the group concluded. “Additional studies that include an assessment of medical therapies of AFib sub-types following TAVR, including variable use of antithrombotic and heart failure medications, are needed to corroborate these findings.”
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Michael has more than 18 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.