Atrial Fibrillation During or After TAVI: Incidence, Implications and Therapeutical Considerations

Vavuranakis, Μanolis; Kolokathis, Angelos–Michail; Vrachatis, Dimitrios; Kalogeras, Konstantinos; Magkoutis, Nikolaos; Fradi, Sabi; Ghostine, Saïd; Karamanou, Marianna; Tousoulis, Dimitrios

doi:10.2174/1381612822666151208123050

Cited by 19 publications

(13 citation statements)

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“… 12 It seems that the more invasive character of transapical TAVIs accompanied by epicardial and pericardial injury due to transapical access route could justify this association. 12 , 24 Several studies have reported a NOAF incidence of 1%–32% postprocedurally, 12 , 23 , 25 , 26 a finding that is consistent with the present study.…”

Section: Discussionsupporting

confidence: 92%

“…NOAF following TAVI procedures is a well-known complication, 23 while transapical approach has been identified as an independent predictor of this patient outcome. 12 It seems that the more invasive character of transapical TAVIs accompanied by epicardial and pericardial injury due to transapical access route could justify this association.…”

Section: Discussionmentioning

confidence: 99%

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Factors associated with early cardiac complications following transcatheter aortic valve implantation with transapical approach

Patris

Giakoumidakis

Argiriou

et al. 2018

POR

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PurposeTo estimate the incidence of postprocedural early cardiac complications among patients undergoing transcatheter aortic valve implantation, through transapical approach (TA-TAVI), and to identify factors independently associated with the occurrence of them.Patients and methodsA retrospective cohort study of 90 patients, who had undergone TA-TAVI in a tertiary hospital of Liverpool, UK, during a 5-year period (September 2008–October 2013), was conducted. Data on patient demographics, periprocedural characteristics and cardiac complications presented within 30-day post TA-TAVI were collected, retrospectively, using the hospital’s electronic database.ResultsThe overall 30-day incidence of cardiac complications was estimated at 18.9% (n=17/90). The rate of new onset of atrial fibrillation (AF), atrioventricular block requiring permanent pacemaker implantation, shockable cardiac arrest rhythm and cardiac tamponade was 11.1%, 3.3%, 2.2% and 2.2%, respectively. Bivariate analysis found that absence of preoperative AF (p=0.01), receiving of oral inotropes preprocedurally (p=0.01), intravenous inotropic support postprocedurally (p=0.01) and requirement for postprocedural tracheal intubation (p=0.001) were the main factors associated with increased probability for patient cardiac morbidity.ConclusionIt seems that patients with absence of AF and oral inotropic support preprocedurally and those with post TA-TAVI mechanical ventilatory and intravenous inotropic support have greater probability to develop cardiac complications. This knowledge allows the early identification of high-risk patients and supports clinicians to apply both preventive and therapeutic interventions for the optimum patient management and care. In addition, administrators could allocate the health care system resources effectively.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Factors associated with early cardiac complications following transcatheter aortic valve implantation with transapical approach

Patris

Giakoumidakis

Argiriou

et al. 2018

POR

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“…Until now, guidelines have been derived from retrospective studies and meta-analyses [ 14 , 18 , 28 , 45 – 47 ]. As a result, anticoagulation regimens associated with TAVR are primarily either empirical or are administered at the discretion of the attending physician [ 48 , 49 ]. The observed diversity of treatment regimens confirms the clinical challenge of selecting post-procedural medications, even among the patients in this study.…”

Section: Discussionmentioning

confidence: 99%

Analysis of cardiovascular mortality, bleeding, vascular and cerebrovascular events in patients with atrial fibrillation vs. sinus rhythm undergoing transfemoral Transcatheter Aortic Valve Implantation (TAVR)

Herold

Herold-Vlanti

Sherif

et al. 2017

BMC Cardiovasc Disord

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BackgroundTranscatheter aortic valve replacement (TAVR) has been demonstrated to be an established therapy for high-risk, inoperable patients with severe symptomatic aortic valve stenosis. For patients with moderate surgical risk, TAVR is equivalent to conventional aortic valve surgery. However, atrial fibrillation (AF) is also present in many of these patients, thus requiring post-implantation oral anticoagulation therapy in addition to the inhibition of thrombocyte aggregation, which poses the risk of bleeding complications. The aim of our work was to investigate the influence of AF on mortality and the occurrence of bleeding, vascular and cerebrovascular complications related to TAVR according to the VARC-2 criteria.MethodsTwo hundred eighty-three patients who underwent TAVR between March 2010 and April 2016 were retrospectively examined. In total, 257 patients who underwent transfemoral access were included in this study. The mean patient age was 81 ± 6 years, 54.1% of the patients were women, and 42.4% had pre-interventional AF.ResultsCompared to patients with sinus rhythm (SR, n = 148), patients with AF (n = 109) had an almost three-fold higher incidence of major vascular complications (AF 14.7% vs. SR 5.4%, p = 0.016) and life-threatening bleeding (AF 11.9% vs. SR 4.1%, p = 0.028) during the first 30 post-procedural days. However, the rate of cerebrovascular complications (AF 3.7% vs. SR 2.7%, p = 0.726) did not significantly differ between the two groups. Overall mortality was significantly higher in patients with AF during the first month (AF 8.3% vs. SR 2.0%, p = 0.032) and the first year (AF 28.4% vs. SR 15.3%; p = 0.020) following TAVR.ConclusionPatients with AF had significantly more severe bleeding complications after TAVR, which were significantly related to mortality. Future prospective randomized studies must clarify the optimal anticoagulation therapy for patients with AF after TAVR.Trial registration DRKS00011798 on DRKS (Date 17.03.2017).

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“…Conventional antiplatelet‐dominated antithrombotic regimens are increasingly being called into question, especially when patients undergoing TAVR have compelling indications for anticoagulation. Upwards of 30% of patients undergoing TAVR have preexisting atrial fibrillation . Development of NOAF occurs in 1% to 8.6% of the general TAVR population, though the transapical approach is associated with NOAF rates of up to 30%.…”

Section: Pharmacologic Considerations For Patients Undergoing Tavrmentioning

confidence: 99%

“…Upwards of 30% of patients undergoing TAVR have preexisting atrial fibrillation. 42 Development of NOAF occurs in 1% to 8.6% of the general TAVR population, though the transapical approach is associated with NOAF rates of up to 30%. In the 404 patients with atrial fibrillation in the PARTNER 2 trial, 5.5% experienced stroke within 30 days and 8.0% within 12 months.…”

Section: Postprocedural Antithrombotic Management For Patients Undergmentioning

confidence: 99%

Medication Management of Patients Undergoing Transcatheter Aortic Valve Replacement

2017

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Aortic stenosis (AS) is the most common form of valvular heart disease. A detailed diagnostic workup is necessary to promptly stage and classify disease severity to determine optimal management. Medical therapy and valvuloplasty are options that fail to delay or reverse disease progression. Surgical aortic valve replacement (SAVR) is curative but has significant limitations for some patient populations. A newer option, transcatheter aortic valve replacement (TAVR), has become more widely available to patients with intermediate‐ or high‐operative risk. Periprocedural medication management is imperative for successful valve implantation and to minimize adverse events. Stroke remains one of the most common complications of TAVR and is associated with increased mortality. Thus, intra‐ and postprocedural antithrombotic therapy is required, although the regimen that best minimizes thromboembolic events and bleeding complications has yet to be defined. Patients undergoing TAVR with comorbid conditions requiring oral anticoagulation or individuals who develop subvalvular thromboses pose unique challenges. Antiplatelet and anticoagulant therapy should be carefully balanced. This article summarizes key literature supporting the pharmacologic management of patients receiving TAVR.

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Atrial Fibrillation During or After TAVI: Incidence, Implications and Therapeutical Considerations

Cited by 19 publications

References 0 publications

Factors associated with early cardiac complications following transcatheter aortic valve implantation with transapical approach

Factors associated with early cardiac complications following transcatheter aortic valve implantation with transapical approach

Analysis of cardiovascular mortality, bleeding, vascular and cerebrovascular events in patients with atrial fibrillation vs. sinus rhythm undergoing transfemoral Transcatheter Aortic Valve Implantation (TAVR)

Medication Management of Patients Undergoing Transcatheter Aortic Valve Replacement

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