Prevalence and Impact of Atrial Fibrillation in Patients With Severe Aortic Stenosis Undergoing Transcatheter Aortic Valve Replacement

Tarantini, Giuseppe; Mojoli, Marco; Windecker, Stephan; Wendler, Olaf; Lefèvre, Thierry; Saia, Francesco; Walther, Thomas; Rubino, Paolo; Bartorelli, Antonio L.; Napodano, Massimo; D’Onofrio, Augusto; Gerosa, Gino; Iliceto, Sabino; Vahanian, Alec

doi:10.1016/j.jcin.2016.01.037

Cited by 157 publications

(104 citation statements)

References 30 publications

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“…Post‐hoc data from the PARTNER trial and other observational and meta‐analytical studies have shown new‐onset AF to be associated with greater risk for cerebrovascular events at 30 days. However, despite the anticipated adverse effects of AF, we did not observe statistically significant differences in 30‐day risk of outcomes compared with patients in sinus rhythm in this study.…”

Section: Discussioncontrasting

confidence: 80%

“…Compared with paroxysmal AF, persistent AF has been linked with higher risk [4,5]. Recent evidence also suggests that new-onset AF, which has an incidence of 1-38% in TAVR studies, has a pronounced effect on stroke and mortality after TAVR [2,[6][7][8][9]. While procedural factors such as TAVR access can modify the risk of new-onset AF, valve type and post-dilation have also been considered to influence risk of neurological events in these patients [2,3,10,11].…”

Section: Introductionmentioning

confidence: 99%

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Impact of pre‐existing or new‐onset atrial fibrillation on 30‐day clinical outcomes following transcatheter aortic valve replacement: Results from the BRAVO 3 randomized trial

Hengstenberg

Chandrasekhar

Sartori

et al. 2017

Cathet Cardio Intervent

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Section: Discussioncontrasting

confidence: 80%

Section: Introductionmentioning

confidence: 99%

Impact of pre‐existing or new‐onset atrial fibrillation on 30‐day clinical outcomes following transcatheter aortic valve replacement: Results from the BRAVO 3 randomized trial

Hengstenberg

Chandrasekhar

Sartori

et al. 2017

Cathet Cardio Intervent

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“…This association was maintained even after adjusting for other known independent risk factors. 11 In fact, discontinuing beta blockers was found to be the strongest predictor for periprocedural AF in those with known AF as well as for NOAF. There are several potential explanations including a rebound phenomenon, in which the abrupt withdrawal of beta blockers leads to a reactive increase in plasma catecholamines, increased numbers of beta adrenergic receptors (β-AR) and/or an alteration in their affinity for adrenergic agonists, or rebound hypersensitivity to sympathetic stimulation.…”

Section: Discussionmentioning

confidence: 96%

“…In this study, we showed that discontinuing beta blockers prior to TAVR was associated with increased risk of AF. This association was maintained even after adjusting for other known independent risk factors . In fact, discontinuing beta blockers was found to be the strongest predictor for periprocedural AF in those with known AF as well as for NOAF.…”

Section: Discussionmentioning

confidence: 99%

The effect of periprocedural beta blocker withdrawal on arrhythmic risk following transcatheter aortic valve replacement

Younis

Orvin

Nof

et al. 2018

Cathet Cardio Intervent

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Objective To evaluate the efficacy and safety of periprocedural beta‐blocker (BB) discontinuation among patients undergoing transcatheter aortic valve replacement (TAVR) and high degree atrioventricular block (HD‐AVB) and/or atrial fibrillation (AF). Methods The study population comprised 743 consecutive patients who underwent TAVR between 2009 and 2017 in two high‐volume tertiary centers. All patients received chronic BB therapy, and were divided into two groups: (1) BB continuation and (2) BB discontinued 24 hr prior to the procedure. The primary endpoint was the development of composite brady and tachy‐arrhytmic events (including HD‐AVB and/or NOAF) following the procedure. Results Among 743 study patients, 366 (49%) continued BB prior to the procedure and in 377 (51%) chronic BB therapy was discontinued. The rate of the composite periprocedural arrhythmic event was significantly higher among patients who stopped BB (20% vs. 13%, respectively, P = 0.018). Consistently, multivariate analysis showed that discontinuation of BB was associated with two‐fold (P = 0.003) increase in the risk for periprocedural arrhythmic events (OR = 2.0; 95% CI 1.24–3.23; P = 0.004). The association between BB discontinuation and periprocedural arrhythmic events was consistent for the separate endpoints for HDAV and NOAF. Furthermore, the need for permanent pacemaker was significantly higher among patients who discontinued BB (20% vs. 13%; P = 0.018, respectively). Conclusions Among patients undergoing TAVR who receive chronic BB therapy, BB discontinuation prior to the procedure is independently associated with a significant increase in the rate of adverse arrhythmic events, including HDAVB, NOAF, and the need for pacemaker implantation.

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“…3,4,[8][9][10] The American Society of Echocardiography (ASE) and the European Association for Cardiovascular Imaging (EACVI) have proposed a classification for LVEF into normal (>51% in male and >53% in female), mildly abnormal (>40%-51% in male and to 53% in female), moderately abnormal (≥30%-≤40%), and severely abnormal (<30%) thus including different thresholds for males and females. 11 This distinction might be of clinical significance, given the predominance of female patients in most TAVI registries 2,12 and also considering the usually better outcome of female patients. 13 However, the clinical value of this classification for expanded risk stratification based on baseline LVEF has not been studied in patients undergoing TAVI.…”

Section: Introductionmentioning

confidence: 99%

Impact of baseline left ventricular ejection fraction on outcome after transfemoral transcatheter aortic valve implantation in patients with and without low‐gradient aortic stenosis

et al. 2018

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Objectives:To evaluate the impact of baseline left ventricular ejection fraction (LVEF) and its interaction with low-gradient aortic stenosis (LGAS) on all-cause mortality after transfemoral aortic valve implantation (TF-TAVI). Methods:We reviewed mortality data of 624 consecutive single center TF-TAVI patients and categorized LVEF according to current ASE/EACVI recommendations (normal, mildly-, moderately-, and severely abnormal). Results:Baseline LVEF was normal in 336 (53.8%), mildly abnormal in 160 (25.6%), moderately abnormal in 91 (14.6%), and severely abnormal in 37 (5.9%) patients, and 1-year mortality was 19%, 17%, 23%, and 43% (P = 0.002), respectively. Patients with LGAS had a similar 1-year mortality compared to those without LGAS in groups with normal (19% vs 19%, P = 0.899) and mildly abnormal LVEF (16% vs 17%, P = 0.898). One-year mortality of patients with LGAS was significantly greater than in those without LGAS in presence of moderately abnormal LVEF (31% vs 11%, P = 0.022), and it was numerically greater than in those without LGAS in presence of severely abnormal LVEF (48% vs 25%, P = 0.219). In multivariate analysis, only the combination of moderately/severely abnormal LVEF and LGAS predicted increased 1-year mortality (HR: 2.12, 95% CI: 1.4-3.2, P < 0.001). Other variables, including EuroSCORE I did not affect this result. Conclusions:Moderately/severely abnormal LVEF (≤40%) at baseline is associated with increased mortality after TF-TAVI, especially when the mean transvalvular aortic gradient is <40 mm Hg (LGAS), while outcomes in patients with normal and mildly abnormal LVEF are comparable regardless of the pressure gradient across the native aortic valve. (DRKS00013729). K E Y W O R D Sleft ventricular ejection fraction, low-gradient aortic stenosis, mortality, transfemoral aortic valve implantation | 29 EL-CHILALI Et AL.

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Prevalence and Impact of Atrial Fibrillation in Patients With Severe Aortic Stenosis Undergoing Transcatheter Aortic Valve Replacement

Abstract: In the large dataset of the SOURCE XT registry, the presence of either pre-existing or NOAF increased all-cause and cardiac mortality and bleeding events. NOAF was associated with increased stroke rates at long-term follow-up.

Cited by 157 publications

References 30 publications

Impact of pre‐existing or new‐onset atrial fibrillation on 30‐day clinical outcomes following transcatheter aortic valve replacement: Results from the BRAVO 3 randomized trial

Impact of pre‐existing or new‐onset atrial fibrillation on 30‐day clinical outcomes following transcatheter aortic valve replacement: Results from the BRAVO 3 randomized trial

The effect of periprocedural beta blocker withdrawal on arrhythmic risk following transcatheter aortic valve replacement

Impact of baseline left ventricular ejection fraction on outcome after transfemoral transcatheter aortic valve implantation in patients with and without low‐gradient aortic stenosis

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