Pre-Existing and New-Onset Atrial Fibrillation in Patients Undergoing Transcatheter Aortic Valve Implantation

Atrial fibrillation (AF) is a frequent comorbidity in patients with severe aortic valve stenosis undergoing transcatheter aortic valve implantation (TAVI). In addition, new-onset AF can occur after TAVI. However, data on how AF affects outcomes in patients undergoing TAVI remain conflicting.

To assess clinical outcomes in patients with severe aortic valve stenosis with AF who undergo TAVI in a large real-world global cohort.

The CENTER2-study includes 25,771 patients that underwent TAVI between 2007 and 2022. The database consists of patient-level pooled data from 10 clinical studies. Objectives were rates of new-onset AF ≤ 30 days, and differences in mortality and stroke according to AF status.

A total of 23,320 patients were included in the current analysis (56.1% female; mean age 81.5 ± 6.7 years). Pre-existing AF was present in 28.2% (n = 6579) of patients. Mortality rates after TAVI were higher in patients with pre-existing AF (19.0% vs. 14.2%, adjusted HR: 1.39, 95% CI: 1.26-1.53, p < 0.001). Strokes at Day 3-30 after TAVI were more frequent in patients with pre-existing AF (1.6% vs. 1.1%, p = 0.004). New-onset AF occurred in 6.2% (n = 681) of patients without pre-existing AF. Mortality rates after TAVI were higher in patients with new-onset AF (adjusted HR 1.75, 95% CI 1.24-2.49, p = 0.002). One-year stroke was more frequently observed in patients with new-onset AF after exclusion of acute periprocedural stroke (6.1% vs. 3.4%, p = 0.04). Major bleeding was also more frequent in patients with new-onset AF (12.0% vs. 6.7%, p < 0.001).

Patients with pre-existing or new-onset AF had higher mortality compared with patients without AF undergoing transfemoral TAVI. After the acute postprocedural period, 1-year stroke rates were higher in patients with new-onset AF.

ClinicalTrials.gov. Unique identifier NCT03588247.