Patients with new-onset atrial fibrillation after TAVI have highest risk of complications

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Amit N Vora (Duke University Medical Center/the Duke Clinical Research Institute, Durham, USA) and others report in in JACC: Cardiovascular Interventions that patients who develop atrial fibrillation after undergoing transcatheter aortic valve implantation (TAVI) have a higher risk of death, stroke, and myocardial infarction than patients with existing atrial fibrillation undergoing TAVI. The paper is the first nationwide examination of patients who developed atrial fibrillation for the first time following TAVI.

Prior research has shown that if a patient has atrial fibrillation before TAVI, they are much more likely to have worse outcomes after the procedure in comparison to patients who do not have the condition. When it comes to patients who did not have atrial fibrillation before TAVI, but developed it after the procedure, data [for outcomes] has been limited until now.

The study looked at data from the STS/ACC TVT Registry, linked with outcomes data from the Centers for Medicare and Medicaid Services. Vora et al analysed 13,356 patients undergoing TAVI at 381 sites across the USA. From this group, 1,138 patients developed atrial fibrillation for the first time after the procedure. The study focused on how often new atrial fibrillation was occurring, how it was managed if it did happen, and what the outcomes were for patients who developed atrial fibrillation after TAVI.

The analysis found that patients who developed new-onset atrial fibrillation following TAVI were more likely to be female, older and have severe chronic obstructive pulmonary disease. TAVI that was not performed via transfemoral access was also shown to be associated with the development of new-onset atrial fibrillation.

“We found that about 8% of patients undergoing TAVI that did not have pre-existing atrial fibrillation developed new-onset atrial fibrillation after their procedure. When you combine patients that had atrial fibrillation prior to the TAVI procedure and those that develop it after, more than one-half of all patients undergoing TAVI have to also deal with co-existing atrial fibrillation,” says Vora.

The study also examined short- and long-term outcomes among patients who developed new-onset atrial fibrillation. Rates of in-hospital death, stroke and heart attack were all higher among new-onset atrial fibrillation patients. Additionally, these patients were at a 37% higher risk of death one year after the TAVI procedure as well.

Vora comments: “Current guidelines are murky regarding the optimal treatment strategy for these patients, who often tend to be at high risk for stroke but also high risk for bleeding. Although there are a number of trials that are examining various strategies for this population, we need to continue to look very closely at this and determine the best care management for these high-risk patients.”

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