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Int J Cardiol. 2016 May 1;210:72-9. doi: 10.1016/j.ijcard.2016.02.073. Epub 2016 Feb 13.

Prognostic value of new onset atrial fibrillation after transcatheter aortic valve implantation: A FRANCE 2 registry substudy.

Author information

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.

KEYWORDS:

Aortic stenosis; Atrial fibrillation; TAVI

PMID:
26930641
DOI:
10.1016/j.ijcard.2016.02.073
[Indexed for MEDLINE]

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