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TAVR, surgical AVR increase risk for new-onset AF
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Patients who underwent transcatheter aortic valve replacement or surgical AVR had an increased risk for new-onset atrial fibrillation, according to a study published in JAMA Internal Medicine.
“Whether the procedure is an open surgical procedure or minimally invasive such as [TAVR], we can all intuitively imagine that putting a prosthetic valve into the heart causes a number of inflammatory, hemodynamic and structural changes,” Pankaj Arora, MD, assistant professor in the division of cardiovascular disease at the University of Alabama at Birmingham, said in a press release. “This may be the reason we see patients commonly develop abnormal heart rhythms like atrial fibrillation after these procedures, particularly given that the population receiving these procedures is typically elderly with a number of other health problems.”
Rajat Kalra, MD, chief fellow in the cardiovascular division at the University of Minnesota in Minneapolis, and colleagues analyzed data from 171,480 patients from the National Inpatient Sample with aortic stenosis who underwent TAVR (n = 48,715; mean age, 81 years; 47% women) or surgical AVR (n = 122,765; mean age, 68 years; 39% women) between January 2012 and September 2015. Other factors that were assessed include race/ethnicity, baseline characteristics in hospitalizations, socioeconomic status and individual comorbidities in hospitalizations.
The primary outcome of interest was the incidence of new-onset AF after surgical AVR and TAVR. Other in-hospital outcomes of interest were mortality, stroke and length of stay in hospitalizations for surgical AVR and TAVR with or without new-onset AF.
New-onset AF was seen in 50.4% of patients hospitalized for TAVR (95% CI, 49.4-51.4) and 50.1% of those hospitalized for surgical AVR (95% CI, 49.5-50.7).
Researchers also analyzed data from a validation cohort of 6,877 patients from the New York state inpatient database who were hospitalized for TAVR and surgical AVR from 2012 to 2014.
Compared with patients who were hospitalized without new-onset AF, those hospitalized for TAVR who developed new-onset AF had an increased risk for in-hospital mortality (OR = 1.57; 95% CI, 1.21-2.04). This was also seen in patients hospitalized for surgical AVR who developed new-onset AF (OR = 1.36; 95% CI, 1.08-1.7).
The results were confirmed through the validation cohort. Incident new-onset AF was common in these patients who underwent TAVR and surgical AVR (14.1% and 30.6%, respectively).
“Our investigation raises the question of how perioperative anticoagulation strategies must be altered for [TAVR] and AVR with such a high incidence of postprocedural atrial fibrillation,” Kalra and colleagues wrote. “This issue is underscored by the relatively high odds of incident in hospital stroke (especially after [TAVR]) that we observed in the multivariable-adjusted analyses.” – by Darlene Dobkowski
Disclosures: The authors report no relevant financial disclosures.
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