Abstract 13560: Incidence, Predictive Factors and Prognostic Value of New-Onset Atrial Fibrillation following Transcatheter Aortic Valve Implantation
Background: Very few data exist on new-onset atrial fibrillation/flutter (NOAF) as a potential complication associated with transcatheter aortic valve implantation (TAVI). The objectives of this study were to evaluate the incidence, predictive factors and prognostic value of NOAF following TAVI.
Methods: A total of 195 consecutive patients (pts) diagnosed with severe symptomatic aortic stenosis underwent TAVI with a balloon-expandable valve at our institution. Of these, 57 pts with prior chronic or paroxysmal AF were excluded leading to a final study population of 138 pts (mean age: 79±8 years, logistic EuroSCORE: 21.7±15.7%). Pts were on continuous ECG monitoring until hospital discharge and NOAF was defined as any episode of atrial fibrilation/flutter lasting >30 sec. All clinical, echocardiographic, procedural and follow-up data were prospectively collected.
Results: NOAF occurred in 43 pts (31.2%) at a median time of 48 hours (IQR: 0-72 hours) following TAVI. The predictive factors of NOAF were indexed left atrial (LA) size (NOAF group: 29.6±6.5 mm/m2 vs. no NOAF group: 24.9±4.2 mm/m2; OR: 1.24 for each increase in 1 mm/m2, 95%CI: 1.11-1.38, p<0.0001), and transapical (TA) approach (NOAF-TA group: 37.0%, NOAF-transfemoral group: 15.8%; OR: 3.54, 95%CI: 1.16-10.78, p=0.022). At 30-day follow-up, NOAF was associated with a higher rate of stroke/systemic embolism (14.0% vs. 3.2%, p=0.026, p=0.031 after adjustment for baseline differences between groups), with no differences in mortality rate between groups (NOAF: 6.9%, no NOAF: 7.4%, p=1.00). At a median follow-up of 12 months (IQR: 1 to 16 months) a total of 27 pts (19.6%) had died, with no differences between NOAF (18.6%) and no NOAF (20.0%) groups, p=1.00. The rate of stroke/systemic embolism at follow-up was 16.3% in the NOAF group vs. 3.2% in the no NOAF group (p=0.010; p=0.012 after adjustment for baseline differences between groups).
Conclusions: About 1/3 of the pts with no history of atrial fibrillation/flutter presented NOAF following TAVI. NOAF was associated with a larger LA size and TA approach, and determined a higher incidence of stroke/systemic embolism acutely and at 1-year follow-up. These results provide new insights on the potential mechanisms of embolic complications after TAVI.
- © 2011 by American Heart Association, Inc.