Abstract
AimsAtrial fibrillation (AF) is associated with increased mortality after transcatheter aortic valve replacement (TAVR). Cerebrovascular complications and bleeding events associated with anticoagulation therapy are discussed to be possible causes for this increased mortality. The present study sought to assess whether AF is associated with impaired left ventricular (LV) reverse remodeling representing another possible mechanism for poor outcome.MethodsAll patients who underwent TAVR in our institution and had 1-year echocardiography follow-up were included. LV mass index (LVMI) at baseline and follow-up as well as LVMI change at 1 year were assessed with respect to the presence of AF (either at baseline or during hospitalization after TAVR) and sinus rhythm (SR).ResultsA total of 213 patients (n = 95 in AF; n = 118 in SR) were enrolled in the present study. Patients with AF had higher LVMI at 1 year compared to those with SR (173 ± 61 g/m2 vs. 154 ± 55 g/m2; p = 0.02) and they showed lower relative LVMI change at 1 year (− 2 ± 28% vs. − 9 ± 29%; p = 0.04). In linear regression analysis, AF was independently associated with relative LVMI change (regression coefficient ß 0.076 [95% CI 0.001–0.150]; p = 0.04). With respect to clinical outcome depending on AF and LVMI regression, the Kaplan–Meier estimated event-free of death or cardiac rehospitalization at 3 years was lowest among patients with AF and no LVMI regression.ConclusionsThe present study identified a significant association of AF with changes in LVMI after TAVR, which was also shown to be associated with clinical outcome.
Highlights
Atrial fibrillation (AF) is one of the most prevalent comorbidities in patients undergoing transcatheter aortic valve replacement (TAVR) [1–3]
There is large evidence that patients with AF show a worse prognosis compared to those with sinus rhythm (SR) after TAVR [2, 4–8]. The reason for this are cerebrovascular complications and bleeding events associated with oral anticoagulation therapy [7] beside the more progressive heart disease observed in AF
AF was diagnosed in 95 patients (45%) with AF prior to TAVR in 88 patients and new AF after TAVR in seven patients
Summary
Atrial fibrillation (AF) is one of the most prevalent comorbidities in patients undergoing transcatheter aortic valve replacement (TAVR) [1–3]. AF is already present prior to TAVR but it can occur after the procedure [2, 4, 5]. In high-risk patients, the prevalence can reach 50% when combining pre-existing and new-onset post-procedural AF. There is large evidence that patients with AF show a worse prognosis compared to those with sinus rhythm (SR) after TAVR [2, 4–8]. The reason for this are cerebrovascular complications and bleeding events associated with oral anticoagulation therapy [7] beside the more progressive heart disease observed in AF.
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