Incidence, Management, and Associated Clinical Outcomes of New-Onset Atrial Fibrillation Following Transcatheter Aortic Valve Replacement

Vora, Amit N.; Dai, Dadi; Matsuoka, Roland; Harrison, J. Kevin; Hughes, G. Chad; Sherwood, Matthew W.; Piccini, Jonathan P.; Bhardwaj, Bhaskar; Lópes, Renato D.; Cohen, David J.; Holmes, David R.; Thourani, Vinod H.; Peterson, Eric D.; Kirtane, Ajay J.; Kapadia, Samir; Vemulapalli, Sreekanth

doi:10.1016/j.jcin.2018.05.042

Cited by 94 publications

(60 citation statements)

References 29 publications

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“…13 BMI, AF, and low serum albumin level have all been discussed previously as predictors of death in TAVR patients. [14][15][16] Nonetheless, this is the first study to demonstrate the effect of TAVR risk score on mid-term outcomes following TAVR.…”

Section: Discussionmentioning

confidence: 88%

Usefulness of the Transcatheter Aortic Valve Replacement Risk Score to Determine Mid-Term Outcomes

Tobaru

Higuchi

Mahara

et al. 2019

Circ J

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Section: Discussionmentioning

confidence: 88%

Usefulness of the Transcatheter Aortic Valve Replacement Risk Score to Determine Mid-Term Outcomes

Tobaru

Higuchi

Mahara

et al. 2019

Circ J

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“…analysis from the TVT Registry has established a similar association between postoperative atrial fibrillation and post-TAVR stroke. 24 Other studies have identified cardioembolic events from the left atrial appendage as a potential mechanism of post-TAVR stroke. 25,26 Strategies to mitigate post-TAVR stroke in patients with atrial fibrillation are needed given that atrial fibrillation is a frequent comorbidity in TAVR candidates.…”

Section: Discussionmentioning

confidence: 99%

“…25,26 Strategies to mitigate post-TAVR stroke in patients with atrial fibrillation are needed given that atrial fibrillation is a frequent comorbidity in TAVR candidates. 24 Although this study did not identify a protective association with oral anticoagulant and 30-day neurologic risk, this analysis included both patients with and without atrial fibrillation with indications for oral anticoagulant therapy, so the association with oral anticoagulant therapy and 30-day post-TAVR stroke in patients with atrial fibrillation was not specifically examined. The WATCH-TAVR Trial (NCT03173534) is currently testing a strategy of TAVR with concomitant percutaneous left atrial appendage closure in patients with atrial fibrillation, which is a novel nonpharmacologic strategy to mitigate stroke risk after TAVR.…”

Section: Discussionmentioning

confidence: 99%

Association Between Transcatheter Aortic Valve Replacement and Early Postprocedural Stroke

Huded

Tuzcu

Krishnaswamy

et al. 2019

JAMA

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149

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IMPORTANCEReducing postprocedural stroke is important to improve the safety of transcatheter aortic valve replacement (TAVR).OBJECTIVE This study evaluated the trends of stroke occurring within 30 days after the procedure during the first 5 years TAVR was used in the United States, the association of stroke with 30-day mortality, and the association of medical therapy with 30-day stroke risk. DESIGN, SETTING, AND PARTICIPANTSRetrospective cohort study including 101 430 patients who were treated with femoral and nonfemoral TAVR at 521 US hospitals in the Society of

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“…[5][6][7][8][9] New-onset AF after transfemoral (TF)-TAVR occurs in 4.4% of patients and substantially increases mortality risk. 10,11 AF is a strong predictor of thromboembolic events, but the benefits of anticoagulation therapy require careful balancing against the increased risk for bleeding. However, the level of evidence is low and there is still uncertainty about the optimal peri-and postprocedural antithrombotic treatment regimen after TAVR, in particular in patients with concurrent AF.…”

Section: Introductionmentioning

confidence: 99%

Bleeding Complications Drive In-Hospital Mortality of Patients with Atrial Fibrillation after Transcatheter Aortic Valve Replacement

et al. 2020

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Background Atrial fibrillation (AF) is a risk factor for poor postoperative outcome after transfemoral transcatheter aortic valve replacement (TF-TAVR). The present study analyses the outcomes after TF-TAVR in patients with or without AF and identifies independent predictors for in-hospital mortality in clinical practice. Methods and Results Among all 57,050 patients undergoing isolated TF-TAVR between 2008 and 2016 in Germany, 44.2% of patients (n = 25,309) had AF. Patients with AF were at higher risk for unfavorable in-hospital outcome after TAVR. Including all baseline characteristics for a risk-adjusted comparison, AF was an independent risk factor for in-hospital mortality after TAVR. Among patients with AF, EuroSCORE, New York Heart Association classification class, or renal disease had only moderate effects on mortality, while the occurrence of postprocedural stroke or moderate to major bleeding substantially increased in-hospital mortality (odds ratio [OR] 3.35, 95% confidence interval [CI] 2.61–4.30, p < 0.001 and OR 3.12, 95% CI 2.68–3.62, p < 0.001). However, the strongest independent predictor for in-hospital mortality among patients with AF was severe bleeding (OR 18.00, 95% CI 15.22–21.30, p < 0.001). Conclusion The present study demonstrates that the incidence of bleeding defines the in-hospital outcome of patients with AF after TF-TAVR. Thus, the periprocedural phase demands particular care in bleeding prevention.

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Incidence, Management, and Associated Clinical Outcomes of New-Onset Atrial Fibrillation Following Transcatheter Aortic Valve Replacement

Cited by 94 publications

References 29 publications

Usefulness of the Transcatheter Aortic Valve Replacement Risk Score to Determine Mid-Term Outcomes

Usefulness of the Transcatheter Aortic Valve Replacement Risk Score to Determine Mid-Term Outcomes

Association Between Transcatheter Aortic Valve Replacement and Early Postprocedural Stroke

Bleeding Complications Drive In-Hospital Mortality of Patients with Atrial Fibrillation after Transcatheter Aortic Valve Replacement

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