Long-Term Maintenance of Sinus Rhythm Is Associated with Favorable Echocardiographic Remodeling and Improved Clinical Outcomes after Transcatheter Aortic Valve Replacement.

Young Choi,Juhan Kim,Wook-Sung Chung,Jin Jin Kim,Byung-Hee Hwang,Ho-Joong Youn,Gyu-Chul Oh,Eunho Choo,Min-Chul Kim,Kiyuk Chang,Hae Ok Jung

doi:10.3390/jcm11051330

Abstract

Periprocedural atrial fibrillation (AF) is associated with poor prognosis after transcatheter aortic valve replacement (TAVR). We evaluated the impact of long-term sinus rhythm (SR) maintenance on post-TAVR outcomes. We enrolled 278 patients treated with TAVR including 87 patients with periprocedural AF. Patients with periprocedural AF were classified into the AF-sinus rhythm maintained (AF-SRM) group or the sustained AF group according to long-term cardiac rhythm status after discharge. Patients without AF before or after TAVR were classified into the SR group. The primary clinical outcome was a composite of all-cause death, stroke, or heart failure rehospitalization. The AF-SRM and the SR groups showed significant improvements in left ventricular ejection fraction and left atrial volume index at one year after TAVR, while the sustained AF group did not. During 24.5 (±16.1) months of follow-up, the sustained AF group had a higher risk of the adverse clinical event compared with the AF-SRM group (hazard ratio (HR) 4.449, 95% confidence interval (CI) 1.614–12.270), while the AF-SRM group had a similar risk of the adverse clinical event compared with the SR group (HR 0.737, 95% CI 0.285–1.903). In conclusion, SR maintenance after TAVR was associated with enhanced echocardiographic improvement and favorable clinical outcomes.

Highlights

Atrial fibrillation (AF) is a highly prevalent arrhythmia in elderly patients with structural heart disease [1]
antiarrhythmic drugs (AAD) was used in 29 patients with periprocedural AF, and amiodarone was used in the majority of patients (24/29)
Prescription rate for AAD was similar in the AF-sinus rhythm maintained (AF-SRM) and the sustained AF groups

Summary

Introduction

Atrial fibrillation (AF) is a highly prevalent arrhythmia in elderly patients with structural heart disease [1]. Coexisting AF was observed in more than 1/3 of patients with severe AS in previous studies [2]. Transcatheter aortic valve replacement (TAVR) is becoming an increasingly popular treatment for patients with severe AS. The clinical outcome after TAVR has gradually improved, and its indication has been expanded; recent data demonstrated that TAVR can be a favorable treatment option even in patients with low surgical risks [3,4]. Periprocedural AF has been shown to have a deleterious effect on hard outcomes in AS patients, even after successful treatment with TAVR [5,6]. Periprocedural AF is divided into two categories according to the timing of detection, pre-existing AF or new-onset AF (NOAF), and both are related to increased adverse clinical events after TAVR [7–13]

Methods

Results

Discussion

Conclusion