Abstract 15838: Baseline Atrial Fibrillation in Patients Undergoing Transcatheter Aortic Valve Replacement is Associated With Poor Long-Term Outcome
INTRODUCTION: Prevalence of atrial fibrillation (AF) among patients undergoing cardiac surgery is low, but it is associated with poor outcome. AF rates were higher among transcatheter aortic valve replacement (TAVR) patients in the PARTNER trials. There are limited data, however, regarding current prevalence and clinical impact of baseline AF on patients with aortic stenosis (AS) undergoing TAVR.
METHODS: Clinical data of patients with aortic stenosis who underwent TAVR from 2007 to 2012 was retrospectively analyzed. Patients were divided into two groups based on prevalence of baseline AF: AF versus no AF. Clinical outcome was recorded up to 12 months. Multivariate analysis was performed to detect correlates for mortality.
RESULTS: A total of 371 patients were included in the analysis. Of them, 143 (39%) had AF at baseline. Baseline characteristics were comparable between groups. However, AF patients were more likely to be male (58% vs. 43%, p=0.005), to have chronic lung disease (37% vs. 27%, p=0.04) and prior valve surgery (7% vs. 0.6%, p=0.006) compared to no-AF patients. Baseline left ventricular function was similar but left atrial diameter was larger in patients with baseline AF (4.8±0.8 vs. 4.4±0.7, p=0.005). Procedural parameters and in-hospital complications did not differ between groups. While early mortality was similar in both groups, a significant mortality difference developed during the follow up leading to higher mortality of AF patients at 1 year (25.9% vs. 17.1%, p=0.02). (Figure) Multivariable analysis for 1-year mortality indicated that the only adjusted parameter associated with higher mortality was prevalence of baseline AF.
CONCLUSIONS: Baseline AF pre-TAVR is common. It is associated with long-term, but not short-term, poor outcome. This pattern may suggest that associated comorbidities are the cause of late hazard and not necessarily the AF itself.
- © 2013 by American Heart Association, Inc.