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AF may worsen mortality outcomes in patients undergoing TAVR
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The presence of atrial fibrillation at discharge after transcatheter aortic valve replacement is associated with increased risk for mortality, according to new data from the PARTNER study.
Researchers analyzed 1,879 patients from PARTNER who were assigned to and underwent TAVR with a balloon-expandable system (Sapien, Edwards Lifesciences) and had baseline and discharge ECGs.
Among the study population, 1,262 patients had sinus rhythm at baseline and at discharge, 113 had sinus rhythm at baseline and AF at discharge, 470 had AF at baseline and at discharge, Angelo B. Biviano, MD, MPH, from the department of medicine at NewYork-Presbyterian Hospital/Columbia University Medical Center, and colleagues reported.
Those with sinus rhythm at baseline and AF at discharge had the highest rate of 30-day mortality at 14.2% compared with 3.6% for those with AF at baseline and discharge and 2.6% for those with sinus rhythm at baseline and discharge (adjusted HR vs. sinus rhythm at baseline and discharge = 3.41; P = .0002). The researchers observed a similar trend in CV mortality, but there was no difference between the groups in rehospitalization, stroke/transient ischemic attack, major bleeding or major vascular events.
At 1 year, the group with sinus rhythm at baseline and AF at discharge had a mortality rate of 35.7% vs. 29.9% for AF at baseline and discharge and 15.8% for sinus rhythm at baseline and discharge (adjusted HR vs. sinus rhythm at baseline and discharge = 2.14; P < .0001; P for trend < .0001). The researchers observed a similar trend in CV mortality and rehospitalization but found no differences in stroke/TIA, major bleeding or major vascular events.
Biviano and colleagues determined that presence of AF at baseline or discharge was an independent predictor for mortality at 1 year (adjusted HR for sinus rhythm/AF group = 2.14; adjusted HF for continuous AF group = 1.88; P for both vs. continuous sinus rhythm group < .0001).
Among those with AF at discharge, the 1-year mortality rate was lower in patients with lower ventricular response, defined as less than 90 bpm (HR = 0.74; P = .04).
“Although it is evident that AF is associated with an increase in mortality in patients who undergo TAVR, it remains unclear whether effective treatment of AF rhythm or rate could reduce this increase in mortality,” Biviano and colleagues wrote. “AF patients undergoing TAVR should be further studied for strategies that improve clinical outcomes.” – by Erik Swain
Disclosure: The PARTNER study was funded by Edwards Lifesciences. Biviano reports no relevant financial disclosures. See the full study for a list of the other researchers’ relevant financial disclosures.
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