October 28, 2019
2 min read

New-onset AF after TAVR confers greater mortality, comorbidity risk

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Patients with new-onset atrial fibrillation after transcatheter aortic valve replacement experienced higher morbidity than those with preexisting or no AF, according to research published in JACC: Cardiovascular Interventions.

After adjusting for patient characteristics and hospital TAVR volume, researchers found that patients with new-onset AF had significantly greater mortality at a median follow-up of 305 days compared with patients with no AF (adjusted HR = 2.06; 95% CI, 1.92-2.2) and preexisting AF (aHR = 1.35; 95% CI 1.26-1.45).

In addition, patients with new-onset AF after TAVR, compared with those with preexisting AF, also had greater risk for:

  • bleeding (subdistribution HR = 1.66; 95% CI, 1.48-1.86);
  • stroke (subdistribution HR = 1.92; 95% CI, 1.63-2.26); and
  • HF admissions (subdistribution HR = 1.98; 95% CI 1.81-2.16).

“While patients with preexisting AF are at higher risk of mortality compared to patients with no AF, new-onset AF carries a significantly worse prognosis and is associated with a much higher risk of mortality,” Amgad Mentias, MD, MSc, cardiology fellow at the University of Iowa Carver College of Medicine, and colleagues wrote. “This was despite that new-onset AF patients had a lower burden of most comorbidities at baseline. Last, patients who undergo TAVR and develop new-onset AF have higher risk of stroke, bleeding and HF hospitalizations at follow-up compared to patients with preexisting AF.”

In other findings, researchers observed that unadjusted mortality was higher with new-onset AF (29.7 per 100 person-years) compared with preexisting AF (22.6 per 100 person-years) and no AF (12.8 per 100 person-years; P < .001) after follow-up of 73,732 person-years.

“New-onset atrial fibrillation after transcatheter aortic valve replacement is associated with worse long-term outcomes compared to patients with preexisting atrial fibrillation and patients with no AF,” the researchers wrote. “Further research is required to determine the optimum prevention and management of new-onset atrial fibrillation after transcatheter aortic valve replacement to improve short- and long-term outcomes.”

Researchers identified via Medicare inpatient claims of 72,660 patients (mean age, 82 years; 53% men; 92% white; 37% with diabetes) who underwent non-apical TAVR between 2014 and 2016. New-onset AF was defined as occurrence of AF during the TAVR admission or within 30 days after TAVR without prior AF history.

Lars Søndergaard

“The worse outcome in patients with new-onset AF may be due to postprocedural morbid and frail patients [being] more extensively rhythm-monitored and some healthier patients could have missed new-onset AF due to early discharge,” Troels Højsgaard Jørgensen, MD, and Lars Søndergaard, MD, DMSc, of the department of cardiology at the Rigshospitalet, Copenhagen University Hospital, Denmark, wrote in a related editorial. “In fact, patients with new-onset AF had significantly longer length of stay in the intensive care unit, a longer length index hospitalization and [were] more frequently re-hospitalized within 30 days (duration of classification) when compared to patients with preexisting AF or without AF.” – by Scott Buzby

Disclosures: One author reports he received grant support from Boston Scientific and Edwards Lifesciences. The other study authors and the editorial authors report no relevant financial disclosures.