Atrial Fibrillation: Important Impact on TAVI

Original Title: Atrial Fibrillation Is Associated With Increased Mortality in Patients Undergoing Transcatheter Aortic Valve Replacement: Insights From the Placement of Aortic Transcatheter Valve (PARTNER) Trial. Reference: Angelo B. Biviano et al. Circ Cardiovasc Interv. 2016 Jan;9(1):e002766.

Courtesy of Dr. Carlos Fava.

The conversion to atrial fibrillation (AF) in the context of transcatheter aortic valve replacement (TAVI) is associated with higher mortality. Patients undergoing TAVI have between 6% and 53% incidence of AF, however, its impact has not yet been studied, as has the impact of CABG.

1879 patients from the Partner trial were analyzed. 1262 of these patients manifested sinus rhythm (SR) at baseline and SR at discharge, 113 SR at baseline and AF at discharge, and 470 AF at baseline and AF at discharge (these las tones were excluded).

STS score was higher and ejection fraction was lower in the AF/AF group.

Baseline SR with first degree VA block was associated with AF at discharge, not those presenting branch block.

At 30 days, the SR/AF group had higher all-cause mortality (14.2% SR/AF vs. 2.6% SR/SR; p=0.0002) with no differences in rehospitalization, stroke, transient ischemic attack, major bleeding and major vascular complications. The need for definite pacemaker was higher in the SR/AF group and were longer in hospital than those presenting AF/AF.

The SR/AF group presented double the mortality rate at one year compared to the rest of the groups (37.5% SR/AF vs. 15.8% SR/SR; HR=2.14; p<0.0001), and they more often required definite pacemakers and rehospitalization for cardiac failure and dialysis.

Mortality in the AF/AF group was 29.9%.  Patients discharged with AF but with <90 ventricular response had lower mortality and cardiac event rates than those with a bad ventricular response.

Conclusion
In patients undergoing TAVI, the presence of atrial fibrillation at discharge is associated to higher mortality. It is important to note that the deleterious effect of atrial fibrillation and the need to take active measures in order to improve outcomes.

Courtesy of Dr. Carlos Fava.
Interventional Cardiologist
Favaloro Foundation – Buenos Aires

More articles by this author

Prospective Analysis of the Feasibility of the PASCAL System for Transcatheter Mitral Repair: OneForAll Registry

Courtesy of Dr. Juan Manuel Pérez. Mitral transcatheter edge-to-edge repair (M-TEER) is an effective option for patients with severe mitral regurgitation who are at high...

Left Bundle Branch Block after TAVR: What Is Its Impact?

Courtesy of Dr. Juan Manuel Pérez. Left bundle branch block (LBBB) is a common complication following transcatheter aortic valve replacement (TAVR), which can be either...

Multicenter Experience with 3D Intracardiac Echocardiography for Guiding Interventional Cardiac Procedures

Courtesy of Dr. Juan Manuel Pérez. Imaging techniques play a fundamental role in interventional cardiac procedures. Intracardiac echocardiography (ICE) appears as an alternative to transesophageal...

Pathology of Self-Expanding Transcatheter Aortic Bioprostheses and Hypoattenuated Leaflet Thickening

Courtesy of Dr. Juan Manuel Pérez. Despite the available long term followup data on of transcatheter aortic valve replacement (TAVR), bioprosthesis durability continues under debate....

LEAVE A REPLY

Please enter your comment!
Please enter your name here

Related Articles

SOLACI Sessionsspot_img

Recent Articles

ACC 2025 | FAME 3: FFR Guided PCI vs CABG 5 Year Outcomes.

Earlier studies comparing percutaneous coronary intervention (PCI) vs coronary artery bypass graft (CABG) have shown fewer events at long term for the surgical strategy.  However,...

ACC 2025 | API-CAT: Reduced vs. Full Dose Extended Anticoagulation in Patients with Cancer Related VTE

The risk of cancer related recurrent venous thromboembolism (VTE) will drop over time, while bleeding risk will persist. At present, it is recommended we...

STRIDE: Semaglutide in Patients with Peripheral Arterial Disease and Type II Diabetes

Peripheral arterial disease (PAD) is a severe complication in patients with type II diabetes, primarily affecting peripheral vessels, especially below-the-knee (BTK) arteries. This condition...