Akira Furuta1, Nicolas Lellouche2, Gauthier Mouillet2, Tarvinder Dhanjal2, Martine Gilard3, Marc Laskar4, Helene Eltchaninoff5, Jean Fajadet6, Bernard Iung7, Patrick Donzeau-Gouge8, Pascal Leprince9, Alain Leuguerrier10, Alain Prat11, Jean-Luc Dubois-Rande2, Emmanuel Teiger2. 1. Cardiology Department, Hôpital Henri-Mondor, Assistance-Publique-Hôpitaux-de-Paris, 51 Avenue du Maréchal de Lattre de Tassigny, 94000 Creteil, France. Electronic address: frtakr@gmail.com. 2. Cardiology Department, Hôpital Henri-Mondor, Assistance-Publique-Hôpitaux-de-Paris, 51 Avenue du Maréchal de Lattre de Tassigny, 94000 Creteil, France. 3. Cardiology Department, Centre-Hospitalier-Universitaire de Brest, Hôpital de la Cavale-Blanche, Boulevard Tanguy Prigent, 29609 Brest, France. 4. Cardiac Surgery Unit, Centre-Hospitalier-Universitaire de Limoges, 2 Avenue Martin Luther king, 87042 Limoges, France. 5. Cardiology Department, Centre-Hospitalier-Universitaire de Rouen, 1 rue de Germont, Rouen, France. 6. Cardiology Department, Clinique Pasteur, Centre de recherche cardiologique, 1 rue de la petite vitesse, 31000 Toulouse, France. 7. Cardiology Department, Centre-Hospitalier-Universitaire Xavier Bichat, Université Paris Diderot, 16 rue Henri-Huchard, 75018 Paris, France. 8. Cardiac Surgery Unit, Institut-Cardiovasculaire Paris-Sud, Massy, France. 9. Cardiac Surgery Unit, Centre-Hospitalier-Universitaire Pitié salpêtrière, Université Paris, France. 10. CHU Rennes, 2 rue Henri le Guilloux, Rennes, France. 11. Cardiac Surgery Unit, Centre-Hospitalier-Universitaire de Lille, 12 rue Jean Jaurès, Lille, France.
Abstract
BACKGROUND: The development of new onset atrial fibrillation (NOAF) post-transcatheter aortic valve implantation (TAVI) is common and may be associated with an adverse prognosis. This study seeks to identify incidence, predictors, and impact of NOAF post-TAVI. METHODS: From the multicenter study of the French national transcatheter aortic valve implantation registry, FRANCE 2, a total of 1959 patients with sinus rhythm prior to TAVI were enrolled into this study. The incidence of post-TAVI NOAF, predictors of development of NOAF and impact on 30-day and 1-year-mortalities were assessed. RESULTS: Of the 1959 TAVI patients (mean-age: 82.6 ± 7.5 years, mean-logistic-EuroSCORE: 21.8 ± 14.3), 149 (7.6%) developed NOAF with the remaining 1810 (92.4%) control patients demonstrating no evidence of AF as defined by the Valve Academic Research Consortium (VARC). Advanced age and major and life-threatening bleeding were independent predictors of NOAF (95% CI: 0.93-0.99; p=0.006, 95% CI: 1.58-4.00; p<0.001, 95% CI: 1.09-3.75; p=0.025, respectively). A trend towards a higher incidence of major and life-threatening bleeding was observed in the patients undergoing TAVI via the transapical (TA)-approach compared with the transfemoral (TF)-approach. Both 30-day and cumulative 1-year-mortalities were significantly higher in patients with NOAF compared to patients without NOAF (3.0% vs. 7.4%; p=0.005, 9.1% vs. 20.8%; p<0.001, respectively). In addition, NOAF was an independent predictor of 30-day and 1-year-mortalities (HR: 2.16; 95% CI: 1.06-4.41; p=0.033, HR: 2.12; 95% CI: 1.42-3.15; p<0.001, respectively). CONCLUSION: Advanced age and major and life-threatening bleeding were independently associated with increased incidence of NOAF, which itself was an independent predictor of 30-day and 1-year-mortalities. With regards to the various transcatheter approaches, a trend towards a higher incidence of major and life-threatening bleeding was observed only with the TA-approach.
BACKGROUND: The development of new onset atrial fibrillation (NOAF) post-transcatheter aortic valve implantation (TAVI) is common and may be associated with an adverse prognosis. This study seeks to identify incidence, predictors, and impact of NOAF post-TAVI. METHODS: From the multicenter study of the French national transcatheter aortic valve implantation registry, FRANCE 2, a total of 1959 patients with sinus rhythm prior to TAVI were enrolled into this study. The incidence of post-TAVI NOAF, predictors of development of NOAF and impact on 30-day and 1-year-mortalities were assessed. RESULTS: Of the 1959 TAVI patients (mean-age: 82.6 ± 7.5 years, mean-logistic-EuroSCORE: 21.8 ± 14.3), 149 (7.6%) developed NOAF with the remaining 1810 (92.4%) control patients demonstrating no evidence of AF as defined by the Valve Academic Research Consortium (VARC). Advanced age and major and life-threatening bleeding were independent predictors of NOAF (95% CI: 0.93-0.99; p=0.006, 95% CI: 1.58-4.00; p<0.001, 95% CI: 1.09-3.75; p=0.025, respectively). A trend towards a higher incidence of major and life-threatening bleeding was observed in the patients undergoing TAVI via the transapical (TA)-approach compared with the transfemoral (TF)-approach. Both 30-day and cumulative 1-year-mortalities were significantly higher in patients with NOAF compared to patients without NOAF (3.0% vs. 7.4%; p=0.005, 9.1% vs. 20.8%; p<0.001, respectively). In addition, NOAF was an independent predictor of 30-day and 1-year-mortalities (HR: 2.16; 95% CI: 1.06-4.41; p=0.033, HR: 2.12; 95% CI: 1.42-3.15; p<0.001, respectively). CONCLUSION: Advanced age and major and life-threatening bleeding were independently associated with increased incidence of NOAF, which itself was an independent predictor of 30-day and 1-year-mortalities. With regards to the various transcatheter approaches, a trend towards a higher incidence of major and life-threatening bleeding was observed only with the TA-approach.
Authors: Dongfeng Zhang; Wei Guo; Mohammed A Al-Hijji; Abdallah El Sabbagh; Bradley R Lewis; Kevin Greason; Gurpreet S Sandhu; Mackram F Eleid; David R Holmes; Joerg Herrmann Journal: J Am Heart Assoc Date: 2019-05-21 Impact factor: 5.501