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AF common after surgical, transcatheter AVR
New-onset atrial fibrillation was a frequent complication after surgical and transcatheter aortic valve replacement in elderly patients with degenerative aortic stenosis, according to recent study findings published in the Journal of the American College of Cardiology.
The single-center, retrospective cohort study included 231 consecutive patients who underwent AVR for degenerative aortic stenosis between March 2010 and September 2012. More than 90% of patients had NYHA class III or IV HF, and the mean Society of Thoracic Surgeons score was 7.67. The mean age was 84.9 years and 48% of the population was male.
After exclusion of patients with a history of paroxysmal, persistent or chronic AF, those with bicuspid aortic valves and those who died within 48 hours after AVR, 123 patients (53%) qualified for inclusion. Researchers reviewed documented episodes of new-onset AF, as well as all clinical, echocardiographic, procedural and 30-day follow-up data.
Overall, 52 patients (42.3%) experienced AF, which varied according to procedural method: surgical AVR, 60%; transapical TAVR, 53%; transaortic TAVR, 33%; and transfemoral TAVR, 14%. The median time for episode occurrence was 53 hours after the procedure.
Furthermore, procedures without pericardiotomy had an 82% risk reduction of AF vs. those with pericardiotomy (adjusted OR=0.18; 95% CI, 0.05-0.59).
Study limitation, according to the researchers, included its small population size, single-center source and retrospective nonrandomized design, as well as the lack of pre-procedural electrocardiographic monitoring and the nature of being a referral center, which could have led to underestimation of the pre-existing paroxysmal atrial arrhythmia.
“Despite its limitations, this was the first study to evaluate the incidence of new-onset atrial fibrillation among elderly patients with degenerative [aortic stenosis] who underwent [surgical] AVR compared with different TAVR approaches,” the researchers wrote, adding that new-onset AF was found in more than 40% of the patients. “Randomized controlled trials studying the impact of access site on the incidence of AF in TAVR are warranted.”
Disclosure: Tanawuttiwat reports no relevant financial disclosures. See the study for a full list of the other researchers’ financial disclosures.