Abstract 13926: Impact of Atrial Fibrillation on Clinical Outcomes in Patients Undergoing Transcatheter Aortic Valve Replacement
Transcatheter aortic valve replacement (TAVR) is a newer treatment for patients with aortic stenosis (AS) who are at increased operative risk. Atrial fibrillaton (AF) coexists among these patients. We investigated the impact of AF on clinical outcomes in patients undergoing TAVR.
Methods: We reviewed data from 137 patients who underwent TAVR (Edward SAPIEN) valve between June 2008 and October 2012. Data on baseline variables and post- TAVR outcomes were analyzed in patients according to the presence of pre- and overall post-TAVR AF.
Results: Prior AF was recorded in 67 patients (48.91 %). Patients with prior AF had a higher incidence of moderate mitral regurgitation (MR) 57.14 % vs. 36.36 %; p = 0.022 and a dilated left atrial (LA) size (46.24 ± 6.17 vs. 41.40 ± 6.37 mm; p < 0.0001) as compared to patients without AF. Post-TAVR AF (composite of new-onset and pre-existing AF) was observed in 82 patients (59.85 %).Patients with pre-existing AF had a higher need of hemodynamic support (59.70 % vs. 30 %, OR: 3.46; 1.71-7.01; p = 0.0006) and a longer hospital stay post- TAVR (15.67 ± 8.12 vs. 11.12 ± 6.36 days; p = 0.0005) as compared to patients without AF. Patients with post- procedural AF had a higher need for hemodynamic support (50/82; 60.98 %) compared to patients in SR after TAVR (11/55; 20 %, OR: 6.25; 95 % CI: 2.82- 13.86; p < 0.0001). Patients with prior AF had a greater cardiac mortality as compared to patients without prior AF (7/67 [10.45%] vs. 1/70 [1.43%], OR: 8.05; 95 % CI: 0.96- 67.35; p = 0.0307).The composite of (overall mortality, stroke, vascular complications and repeat hospitalization in 1 month after TAVR) was higher in patients with prior AF (49.25 % vs. 27.14 %; OR: 2.61; 95 % CI: 1.28- 5.31; p = 0.0087) and also in the patients who had post-procedural AF as compared to patients who were in SR after TAVR (47.56 % vs.23.64 %, OR: 2.93; 95 % CI: 1.37- 6.26; p = 0.0068).
Conclusions: In patients undergoing TAVR for severe AS, both pre- and post-TAVR AF were associated with an increased need for hemodynamic support and a higher composite outcome of (all-cause mortality, stroke, vascular complications and repeat hospitalizations within 1 month after TAVR) as compared to patients who did not have AF.
- © 2013 by American Heart Association, Inc.