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. 2024 Jan 1;25(1):51-59.
doi: 10.2459/JCM.0000000000001553. Epub 2023 Dec 8.

Atrial fibrillation before and after transcatheter aortic valve implantation: short- and long-term clinical implications

Salvatore Arrotti  1 , Fabio Alfredo Sgura  1 , Giulio Leo  1 , Marco Vitolo  1   2 , Daniel Monopoli  1 , Nicola Forzati  1 , Valerio Siena  1 , Matteo Menozzi  1 , Paolo Cataldo  1 , Marco Stuani  1 , Vernizia Morgante  1 , Paolo Magnavacchi  3 , Davide Gabbieri  4 , Vincenzo Guiducci  5 , Giorgio Benatti  6 , Luigi Vignali  6 , Rosario Rossi  1 , Giuseppe Boriani  1
Affiliations

Atrial fibrillation before and after transcatheter aortic valve implantation: short- and long-term clinical implications

Salvatore Arrotti et al. J Cardiovasc Med (Hagerstown). .

Abstract

Background: Patients with atrial fibrillation (AF) undergoing transcatheter aortic valve implantation (TAVI) have been associated with worse short-term outcomes compared with patients in sinus rhythm but data on long-term outcomes are limited. The aim of our study was to evaluate the association between AF and short- and long-term outcomes in patients undergoing TAVI.

Methods: We retrospectively evaluated patients undergoing TAVI between 2012 and 2022 in four tertiary centres. Two different analyses were conducted: (i) in-hospital and (ii) postdischarge analysis. First, we evaluated the association between preexisting AF and short-term outcomes according to VARC-3 criteria. Second, we analyzed the association between AF at discharge (defined as both preexisting and new-onset AF occurring after TAVI) and long-term outcomes at median follow-up of 3.2 years (i.e. all-cause death, hospitalization and major adverse cardiovascular events).

Results: A total of 759 patients were initially categorized according to the presence of preexisting AF (241 vs. 518 patients). The preexisting AF group had a higher occurrence of acute kidney injury [odds ratio (OR) 1.65; 95%confidence interval ( CI) 1.15-2.38] and major bleeding (OR 1.86, 95% CI 1.06-3.27). Subsequently, the population was categorized according to the presence of AF at discharge. At the adjusted Cox regression analysis, AF was independently associated with an increased risk of all-cause death and cardiovascular hospitalization [adjusted hazard ratio (aHR) 1.42, 95% CI 1.09-1.86], all-cause death and all-cause hospitalization (aHR 1.38, 95% CI 1.06-1.78) and all-cause hospitalization (aHR 1.59, 95% CI 1.14.2.22).

Conclusions: In a real-world cohort of patients undergoing TAVI, the presence of AF (preexisting and new-onset) was independently associated with both short- and long-term adverse outcomes.

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Conflict of interest statement

G.B. received small speaker's fees from Boston, Boehringer, Bayer, Daiichi-Sankyo, Janssen and Sanofi, outside of the submitted work. The other authors declare no conflict of interest.

Figures

Fig. 1
Fig. 1
Kaplan–Meier curves for the primary and secondary long-term outcomes according to the presence of AF at discharge.
See this image and copyright information in PMC

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