Abstract 11042: New-Onset Atrial Fibrillation After Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-Analysis

Abstract

Background: New-onset atrial fibrillation (NOAF) is a common complication after transcatheter aortic valve replacement (TAVR), though estimates of the precise incidence are variable. We sought to quantify the incidence of NOAF after TAVR, explore the associated outcomes and identify predictors for this complication. Methods: Using a broad strategy, we searched Medline, EMBASE and the Cochrane database from 2015-2020 for articles that reported any outcomes of TAVR. We extracted data for studies published prior to 2015 from a previous systematic review (22 studies in total). Reviewers performed screening and data extraction in duplicate. We pooled data using a random effects model with Mantel-Haenszel weighting. Results: We identified 183 studies with 296,986 total participants that reported NOAF from 2008 to 2020. The pooled incidence of NOAF after TAVR was 9.9% (95%CI 8.1-12%). NOAF after TAVR was associated with longer index hospitalization (MD 2.66 days, 95% CI 1.05-4.27), higher risk of stroke (RR 1.65, 95% CI 1.09-2.5) and 30-day mortality (RR 1.76, 95%CI 1.12-2.76). NOAF after TAVR was also associated with increased risk of major or life-threatening bleeding (RR 1.60, 95%CI 1.39-1.84) and new permanent pacemaker implantation (RR 1.12, 95%CI 1.05-1.18). Risk factors for the development of NOAF after TAVR included trans-apical access, pulmonary hypertension, chronic kidney disease, peripheral vascular disease, and severe mitral regurgitation. Conclusions: NOAF is common after TAVR and associated with a longer hospital stay, a higher risk of stroke, major bleeding, mortality and permanent pacemaker implantation. Whether this risk is modifiable requires further study.