Abstract 12634: Impact of New-Onset Atrial Fibrillation (NOAF) versus Pre-Existing Atrial Fibrillation on Outcomes After Transcatheter Aortic Valve Replacement/Implantation (TAVR/TAVI)

Abstract

Background: Aortic stenosis patients who undergo Transcatheter Aortic Valve Replacement/Transcatheter Aortic Valve Implantation (TAVR/TAVI) experience a high incidence of pre-existing atrial fibrillation and new-onset atrial fibrillation (NOAF) post-operatively. We aim to update current evidence concerning the incidence of 30-day mortality, stroke, acute kidney injury, length of stay, and early/late bleeding in TAVR/TAVI with NOAF or pre-existing atrial fibrillation (preAF). Methods: We searched Pubmed, Google Scholar, JSTOR, Cochrane Library and Web of Science for studies published between January 2012 and December 2020 that reported the association between NOAF/preAF and clinical complications after TAVR/TAVI. Relevant studies were included in our systematic review and meta-analysis. Our primary clinical outcomes included 30-day mortality, stroke, early bleeding, and late bleeding. The secondary clinical outcomes included acute kidney injury and extended length of stay. Results: We included 15 studies based on 158,220 TAVI/TAVR adult patients (>18 years of age) with NOAF or preAF. Compared to patients in sinus rhythm, TAVR/TAVI patients who developed NOAF had higher risk of 30-day mortality, acute kidney injury, early bleeding events, extended length of stay and stroke (OR: 3.18 [95% CI 1.58, 6.40]) (OR: 3.83 [95% CI 1.18, 12.42]) (OR: 1.70 [95% CI 1.05, 2.74]) (OR: 13.96 [95% CI, 6.41, 30.40]) (OR: 2.51 [95% CI 1.59, 3.97], respectively). Compared to patients in sinus rhythm, TAVR/TAVI patients with pre-AF had higher risk of acute kidney injury and early bleeding episodes (OR: 2.43 [95% CI 1.10, 5.35]) (OR: 17.41 [95% CI 6.49, 46.68], respectively). Pre-AF was not associated with an increase in 30-day mortality, late bleeding, stroke, and length of stay after TAVR/TAVI. Conclusions: The findings of our meta-analysis showed that atrial fibrillation (AF) was associated with higher risk of all primary and secondary outcomes. Specifically, NOAF but not pre-AF was associated with higher risk of 30-day mortality, stroke, and extended length of stay in TAVR/TAVI patients.