Author + information
- Received July 25, 2010
- Revision received August 24, 2011
- Accepted September 20, 2011
- Published online January 10, 2012.
- Ignacio J. Amat-Santos, MD,
- Josep Rodés-Cabau, MD⁎ (, )
- Marina Urena, MD,
- Robert DeLarochellière, MD,
- Daniel Doyle, MD,
- Rodrigo Bagur, MD,
- Jacques Villeneuve, MD,
- Mélanie Côté, MSc,
- Luis Nombela-Franco, MD,
- François Philippon, MD,
- Philippe Pibarot, DVM, PhD and
- Eric Dumont, MD
- ↵⁎Reprint requests and correspondence:
Dr. Josep Rodés-Cabau, Quebec Heart & Lung Institute, Laval University, 2725 chemin Ste-Foy, G1V 4G5 Quebec City, Quebec, Canada
Objectives This study sought to evaluate the incidence, predictive factors, and prognostic value of new-onset atrial fibrillation (NOAF) following transcatheter aortic valve implantation (TAVI).
Background Very few data exist on the occurrence of NOAF following TAVI.
Methods A total of 138 consecutive patients with no prior history of atrial fibrillation (AF) underwent TAVI with a balloon-expandable valve. Patients were on continuous electrocardiogram monitoring until hospital discharge, and NOAF was defined as any episode of AF lasting >30 s. All clinical, echocardiographic, procedural, and follow-up data were prospectively collected.
Results NOAF occurred in 44 patients (31.9%) at a median time of 48 h (interquartile range: 0 to 72 h) following TAVI. The predictive factors of NOAF were left atrial (LA) size (odds ratio [OR]: 1.21 for each increase in 1 mm/m2, 95% confidence interval [CI]: 1.09 to 1.34, p < 0.0001) and transapical approach (OR: 4.08, 95% CI: 1.35 to 12.31, p = 0.019). At 30-day follow-up, NOAF was associated with a higher rate of stroke/systemic embolism (13.6% vs. 3.2%, p = 0.021, p = 0.047 after adjustment for baseline differences between groups), with no differences in mortality rate between groups (NOAF: 9.1%, no-NOAF: 6.4%, p = 0.57). At a median follow-up of 12 months (interquartile range: 5 to 20 months), a total of 27 patients (19.6%) had died, with no differences between the NOAF (15.9%) and no-NOAF (21.3%) groups, p = 0.58. The cumulative rate of stroke and stroke/systemic embolism at follow-up were 13.6% and 15.9%, respectively, in the NOAF group versus 3.2% in the no-NOAF group (p = 0.039, adjusted p = 0.037 for stroke; p = 0.020, adjusted p = 0.023 for stroke/systemic embolism).
Conclusions NOAF occurred in about one-third of the patients with no prior history of AF undergoing TAVI and its incidence was increased in patients with larger LA size and those undergoing transapical TAVI. NOAF was associated with a higher rate of stroke/systemic embolism, but not a higher mortality, at 30 days and at 1-year follow-up.
- atrial fibrillation
- transcatheter aortic valve implantation
- transcatheter aortic valve replacement
Dr. Amat-Santos received support from the Institute of Heart Sciences (ICICOR, Clinical Hospital of Valladolid, Spain). Dr. Rodés-Cabau is a consultant for Edwards Lifesciences Inc. and St. Jude Medical. Dr. DeLarochellière is a consultant for St. Jude Medical. Drs. Doyle and Dumont are consultants for Edwards Lifesciences Inc. The other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received July 25, 2010.
- Revision received August 24, 2011.
- Accepted September 20, 2011.
- American College of Cardiology Foundation