Prognostic Significance Of Atrial Fibrillation Research Articles

The Prognostic Significance of Atrial Fibrillation and Left Atrium Size in Patients with Aortic Stenosis.

Aim Aortic stenosis increases left atrial (LA) pressure and may lead to its remodeling. This can cause supraventricular arrhythmia. The aim of this study was to determine if the size of the LA and the presence of atrial fibrillation are related to the prognosis of patients with aortic stenosis.Material and methods Clinical evaluation and standard transthoracic echocardiographic studies were performed in 397 patients with moderate to severe aortic stenosis.Results In all patients, LA dimension above the median (≥43 mm) was associated with a significantly higher risk of death [HR 1.79 (CL 1.06-3.03)] and a LA volume above the median of 80 ml was associated with a significantly higher risk of death [HR 2.44 (CI 1.12-5.33)]. The presence of atrial fibrillation was significantly associated with a higher risk of death (p <0.0001). The presence of atrial fibrillation [HR 1.69 (CI 1.02-2.86)], lower left ventricular ejection fraction [HR 1.23 (CI 1.04-1.45)], higher NYHA heart failure class [HR 4.15 (CI 1.40-13.20)] and renal failure [HR 2.10 (CI 1.31-3.56)] were independent risk factors of death in patients in aortic stenosis.Conclusion The size and volume of the LA and the occurrence of atrial fibrillation are important risk factors for death in patients with aortic stenosis. The presence of renal dysfunction, low left ventricular ejection fraction, high NYHA functional class and atrial fibrillation are independent risk factors of poor prognosis in patients with aortic stenosis.

Atrial fibrillation in patients with dilated cardiomyopathy: prevalence, risk factors and prognostic significance

Aim. To study the epidemiological profile and long-term prognostic significance of atrial fibrillation (AF) as a risk factor for adverse clinical outcomes in patients with dilated cardiomyopathy (DCM).Material and methods. The study included 270 patients with DCM (206/76,3% men, age 47 [37; 56] years, left ventricular (LV) ejection fraction 29 [21; 35]%). The observation period was 6 years (Me 76 [57; 119] months). To assess the effect of AF on DCM prognosis, Kaplan-Meier curves and Cox regression of clinical outcomes, including cardiovascular death, heart transplantation, and ventricular assist device implantation, were analyzed.Results. Of 270 patients with DCM, paroxysmal AF was detected in 10 (3,7%) patients (initial, 5/1,85%; during the first follow-up year, 5/1,85%). After 5 years, another 65 (24,1%) individuals had AF (paroxysmal, persistent or permanent). Ventricular tachyarrhythmias were registered in 163 (60,4%) patients. Compared with patients maintaining sinus rhythm, patients with AF were older (51,4±10 vs 43,6±13 years, p=0,001) and had lower exercise tolerance (6-minute walk test: 379±45 vs 445±43 meters; p=0,0002) and a higher heart failure functional class (NYHA class III-IV: 38/50,7% vs 52/26,7%; χ2=13,6; p=0 ,0003). In patients with AF, initially more pronounced manifestations of right ventricular contractile dysfunction (TAPSE: 13,1±3,4 vs 15,5±4,6 mm; p=0,0001) and LV diastolic dysfunction (E/A: 2,9±1,5 vs 2,1±1,3; p=0,006; E/e' 15,6±6,9 vs 11,8±7,2; p=0,019), more dilated left atrium (left atrial volume index: 63,3±19 vs 50±18,7 ml/m2; p=0,006). During the 6-year median follow-up, AF was observed in 75 patients (0,46 new cases/100 patients/year). As a result of Cox regression analysis, AF as a time-dependent factor was identified as an independent predictor of cardiovascular death (hazard ratio 3,99; 95% confidence interval, 1,67-8,59; p=0,0001).Conclusion. AF, as one of the most common sustained atrial tachyarrhythmias in the population, demonstrated a lower prevalence (27,8%) in the DCM cohort compared to ventricular tachyarrhythmias (60,4%), but a high prognostic significance of the negative impact on the risk of fatal outcomes. The development of AF in patients with DCM is associated with a 4-fold increase in cardiovascular death risk over a 6-year period.

Association of atrial fibrillation with survival in patients with low-flow low-gradient aortic stenosis with preserved ejection fraction undergoing TAVI.

There is limited evidence on the prognostic significance of atrial fibrillation (AF) in patients with low flow, low-gradient aortic stenosis with preserved ejection fraction (LFLG-pEF AS). We aimed to evaluate the recovery of stroke volume after transcatheter aortic valve implantation (TAVI) and clinical outcomes in patients with LFLG-pEF AS stratified by presence or absence of AF. In a prospective TAVI registry, patients with preserved left ventricular ejection fraction (LVEF≥50%) were stratified according to flow-gradient status and presence of AF. Among 2259 TAVI patients with preserved LVEF between August 2007 and June 2021, 765 had high-gradient AS (HG AS) and 444 had LFLG-pEF AS. AF was observed in 199 patients with HG AS (26.0%) and 190 patients with LFLG-pEF AS (42.8%). At 1 year, stroke volume index (SVi) was significantly improved in LFLG-pEF AS patients without AF, while SVi remained low in patients with AF (from 25.9±8.5mL/m2 to 37.2±9.9mL/m2 and from 26.8±5.1mL/m2 to 26.1±9.1mL/m2, respectively). LFLG-pEF AS patients with AF had an increased risk of 1-year all-cause mortality compared with those without AF (adjusted hazard ratio (HRadjusted) 2.57; 95% confidence interval [CI] 1.44-4.59). LFLG-pEF AS patients without AF had similar mortality compared with HG AS patients without AF (HRadjusted 0.85; 95% CI 0.49-1.46). Patients with LFLG-pEF AS and AF experienced no relevant recovery of stroke volume after TAVI, but a more than two-fold increased risk of death compared to patients with HG AS or LFLG-pEF AS without AF. https://www.clinicaltrials.gov. NCT01368250.

Abstract 15080: Higher Mortality Risk in Very Severe Aortic Stenosis Associated With Atrial Fibrillation

Background: Atrial fibrillation (AF) in severe aortic stenosis (AS) is associated with worse outcomes compared to sinus rhythm (SR). The prevalence of AF and its impact on outcomes in very severe AS (vsAS) is unknown. Objectives: To determine the prevalence and prognostic significance of AF in vsAS. Methods: A total of 563 patients with vsAS (transaortic valve peak velocity ≥5 m/sec) were identified retrospectively out of 3139 with aortic valve area ≤1.0 cm 2 or ≤0.6 cm 2 /m 2 and left ventricular ejection fraction (LVEF) ≥50%. Patients were divided by rhythm (AF vs SR) at the time of index transthoracic echocardiogram. Outcomes in AF versus SR were compared in propensity-matched analyses (2 SR:1 AF). Results: AF was present in 50/563 patients (9%) and SR in 513/563 (91%). In propensity-matched analyses (100 SR:50 AF), the mean age was 83.2±7.3 years, 54% were female. There was no difference in comorbidity index (p=0.84). There was no difference in AF compared to SR in aortic valve area (0.7±0.1 vs 0.7±0.1 cm 2 , p=0.94), peak velocity (5.3±0.3 vs 5.3±0.3 m/sec, p=0.32), LVEF (63±7 vs 65±7%, p=0.14) or E/e’ (23±13 vs 21±12, p=0.48), but patients with AF had larger left atrial volume index (60±16 vs 48±15 mL/m 2 , p<0.001), higher right ventricular systolic pressure (52±15 vs 41±16 mmHg, p<0.001), and higher prevalence of moderate or more tricuspid regurgitation (33% vs 5%, p<0.001) and right ventricular systolic dysfunction (23% vs 6%, p=0.003). Age-, sex-, comorbidity index-adjusted all-cause mortality was higher in AF vs SR (HR 2.33 [1.40, 3.87], p=0.001) ( Figure: Observed overall survival ). Aortic valve replacement (AVR) was associated with improved survival (HR 0.44 [0.25, 0.76], p=0.004) with no evidence of interaction of AVR and rhythm (p=0.15). Conclusion: AF was not uncommon among patients with vsAS and identified a subset of patients with vsAS at much higher risk of mortality. Whether AVR should be considered earlier in vsAS when associated with AF needs to be investigated.

Frequency and prognostic significance of atrial fibrillation in acute pulmonary embolism: A pooled analysis

ObjectiveTo summarize data on the prevalence/incidence, risk factors and prognosis of atrial fibrillation (AF) in patients with acute pulmonary embolism (aPE). MethodsMEDLINE, Embase, and Web of Science were searched to identify all published studies providing relevant data through December 12, 2021. Random-effects meta-analysis method was used to pool estimates. ResultsWe included 27 studies reporting data from a pooled population of 819,380 patients. The prevalence rates were 11.3% for pre-existing AF, 4.7% for newly diagnosed AF, and 13.2% for prevalent (total) AF. Predictors of newly diagnosed AF (from one study) included congestive heart failure (adjusted odds ratio [aOR] 3.33, 95% CI: 1.81–6.12), ischemic heart disease (aOR 3.25, 95% CI: 1.65–6.39), massive PE (aOR 2.67, 95% CI: 1.19–5.99). Overall, AF was associated with increased risk of short-term (aOR 1.54, 95% CI: 1.44–1.64) and long-term mortality (aOR 1.58, 95% CI: 1.26–1.97). In subgroup analyses, all types of AF were associated with increased risk of short-term mortality: pre-existing AF (aOR 1.90, 95% CI: 1.59–2.27), newly diagnosed AF (aOR 1.51, 95% CI: 1.18–1.93), and prevalent AF (aOR 1.50, 95% CI: 1.42–1.60). Pre-existing AF (aOR 2.08, 95% CI: 1.27–3.42) and prevalent AF (aOR 1.29, 95% CI: 1.02–1.63) were also associated with higher long-term mortality. ConclusionAF is present in about one in eight patients with aPE, and is associated with increased short- and long-term mortality. AF might improve risk stratification in patients with aPE.

Pathogenesis and clinical significance of atrial fibrillation in myocardial infarction

Currently, there is no information in novel clinical guidelines on the importance of active detection of atrial fibrillation (AF) in myocardial infarction (MI), as well as on the management of such patients. The aim of this review was to present actual information about possible risk factors, features of pathogenesis, as well as the prognostic significance of AF in MI. Analysis of the literature has shown that many researchers divide AF into new-onset AF (developed after MI) and chronic AF (existing in history before MI). New-onset AF is common complication in MI according to different studies (from 3 to 28% among all patients with MI), which is associated with death and cardioembolic events. Moreover, in every third patient with MI, AF is asymptomatic, which makes it extremely urgent to develop special algorithms aimed at its active search.

Atrial Fibrillation is related with higher in-hospital morality in acute myocardial infarction (AMI) patients from K-ACTIVE registry

Abstract Background The prognostic significance of atrial fibrillation (AF) on in-hospital mortality in acute myocardial infarction (AMI) patients is not fully understood in Japanese patients. Methods To elucidate the clinical significance of AF on in-hospital mortality in AMI patients, we analyzed the Japanese observational prospective multicenter registry of acute myocardial infarction (K-ACTIVE: Kanagawa ACuTe cardio Vacular rEgistry), which spans October 2016 to December 2019. Results A total of 3482 patients included 336 patients with AF and 3146 patients with sinus rhythm. Table 1 shows patient baseline characteristics. Patients with AF were significantly older than those with sinus rhythm (75 vs 67, P<0.0001). Prevalence of hypertension and hemodialysis were significantly greater in patients with AF than patients with sinus rhythm while prevalence of dyslipidemia and smoking were significantly less in patients with AF than patients with sinus rhythm. Table 2 shows characteristics of AMI. There were no significant difference in prevalence of STEMI, area of MI, Peak CK/CK-MB and prevalence of multivessel disease. However, patients with AF showed lower systolic blood pressure, faster heart rate, worse Killip category, greater prevalence of OHCA. Need of mechanical support including IABP/ECMO were greater in patients with AF than patients with sinus rhythm. In-hospital mortality was significantly higher in patients with AF than in patients with sinus rhythm (Figure, 10.4% versus 5.2%, P=0.0005). This trend didn't change even after adjustment with age and sex (Odds ratio 1.6 95% confidence interval 1.1–2.4, P=0.02). Conclusion AF was associated with higher in-hospital mortality in Japanese AMI patients. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): This work was supported by JSPS KAKENHI Grant Number JP15K09101.

Atrial fibrillation is not an independent predictor of outcome in patients with aortic stenosis

ObjectivesTo examine the prognostic significance of atrial fibrillation (AF) versus sinus rhythm (SR) on the management and outcomes of patients with severe aortic stenosis (AS).Methods1847 consecutive patients with severe AS...

Incidence and Prognostic Impact of Atrial Fibrillation After Discharge Following Revascularization for Significant Left Main Coronary Artery Narrowing

The incidence, recurrence rate, and prognostic significance of atrial fibrillation or flutter (AF) following hospital discharge after percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) for left main coronary artery disease (LMCAD) are unknown. We sought to determine the 3-year incidence and clinical impact of postdischarge AF in patients with LMCAD treated with PCI or CABG. In the EXCEL trial, 1,905 patients with LMCAD were randomized to PCI versus CABG. We analyzed the occurrence of postdischarge AF through 3 years and its time-adjusted association with adverse outcomes. A total of 1,802 patients without AF at baseline comprised the study cohort. Within 3 years, 227 episodes of AF occurred (29 [12.8%] in the PCI arm and 198 [87.2%] in the CABG arm, p <0.0001); of those, 63 (27.7%) occurred following discharge from the index hospitalization in 57 patients. In-hospital AF predicted postdischarge AF (hazard ratio [HR] 2.94, 95% confidence interval [CI] 1.42 to 6.10, p = 0.004). By multivariable analysis, time-updated postdischarge AF was an independent predictor of 3-year cardiovascular death (HR 4.91, 95% CI 1.92 to 12.60, p = 0.0009), stroke (HR 4.87, 95% CI 1.12 to 21.12, p = 0.035), and the composite outcome of death, stroke or myocardial infarction (HR 3.09, 95% CI 1.56 to 3.6-6.11, p = 0.001). Among patients with postdischarge AF, the rate of the primary composite outcome did not vary according to presence or absence of in-hospital AF (21.0% vs 23.8%, p = 0.78). In conclusion, postdischarge AF following CABG or PCI for LMCAD is associated with increased mortality and stroke. In-hospital atrial fibrillation is an independent predictor of AF following discharge.

The burden of atrial fibrillation and its prognostic value in patients with dilated cardiomyopathy.

Atrial fibrillation (AF) is the most common arrhythmia in patients with dilated cardiomyopathy (DCM). However, the epidemiology as well as clinical and prognostic significance of AF in DCM are poorly defined. We aimed to assess the impact and prognostic value of AF in DCM as well as to investigate the concept of AF‑induced DCM. Hospital records of 285 patients with DCM from 2012 to 2018 with follow-up were analyzed. Atrial fibrillation was present in 89 patients (31%). They were older, more frequently male, hadhigher body mass index, New York Heart Association class, heart rate (HR), creatinine levels, and larger atria (all P < 0.05) than patients without AF. During follow‑up (mean [SD], 35 [24] months), death occurred in 20 of the 82 available patients with AF and 22 of the 188 patients without AF (24% and 12%, respectively; P = 0.007). Atrial fibrillation was independently associated with a worse outcome (hazard ratio, 2.4; 95% CI, 1.3-4.3) and was found to be the major cause of DCM in 21 patients (24%). The diagnostic accuracy of the most optimal predictive model for AF‑induced DCM was 0.935 (95% CI, 0.903-0.967). Despite numerical differences, survival was similar in DCM patients with and without AF (P = 0.15). Almost one‑third of patients with DCM had AF. Most of the parameters analyzed differed between patients with and without AF, and AF was found to be an independent prognostic factor of DCM. One‑fourth of patients with DCM and AF met the diagnostic criteria for AF‑induced DCM.

The Prevalence and Prognostic Significance of Atrial Fibrillation in Patients with Heart Failure and Preserved Ejection Fraction

The Prevalence and Prognostic Significance of Atrial Fibrillation in Patients with Heart Failure and Preserved Ejection Fraction

P1494The prognostic significance of atrial fibrillation in patients with ST-elevation myocardial infarction: a sub-study of the randomized TOTAL trial

P1494The prognostic significance of atrial fibrillation in patients with ST-elevation myocardial infarction: a sub-study of the randomized TOTAL trial

Prognostic significance of atrial fibrillation in acute decompensated heart failure with reduced versus preserved ejection fraction.

The prognostic impact of atrial fibrillation (AF) in patients with acute decompensated heart failure (ADHF) has not been fully elucidated yet. Aim of the present study was thus to investigate the association of AF with all-cause mortality in patients with reduced ejection fraction (HFrEF) and preserved ejection fraction (HFpEF). We performed a retrospective single center study and analyzed data of 1286 patients admitted for ADHF. Patients were grouped according to AF status (i.e., "never AF", "history of AF", or "AF on admission") and type of heart failure. Patient and treatment characteristics were extracted by chart review. The primary outcome of all-cause mortality within 3years following index hospitalization was determined by death registry linkage. In total, 529 (41.1%), 215 (16.7%), and 542 (42.1%) patients were grouped as "never AF", "history of AF", and "AF on admission", respectively. With regard to type of heart failure, 558 (43.4%) and 728 (56.6%) had HFrEF and HFpEF, respectively. Compared to "never AF", "AF on admission" was associated with increased all-cause mortality in an adjusted Cox regression model [hazard ratio, 1.64 (95% confidence interval 1.32-2.04); P < 0.001]. However, this association remained significant only for patients with HFpEF [2.16 (1.58-2.95)], but not for patients with HFrEF [1.18 (0.85-1.63)] in a subgroup analysis (P for effect modification = 0.020). AF is common in the setting of ADHF and is associated with increased all-cause mortality. However, this association remained significant only in patients with HFpEF, but not in patients with HFrEF.

Predictors and prognostic significance of atrial fibrillation developed during dobutamine stress echocardiography: Apropensity score-matched comparison.

Atrial fibrillation (AF) uncommonly occurs during dobutamine stress echocardiography (DSE). We aimed to characterize the predictors and long-term prognostic significance of AF during DSE. The clinical, echocardiographic, and outcome data of patients in sinus rhythm who developed AF during DSE were reviewed and compared to a propensity score-matched group of controls. Atrial fibrillation developed in 73 (1% of 7026) patients (age 70±10years, 58% men). Compared to 144 propensity score-matched controls without AF during DSE, those with AF were more likely to have had history of prior AF (23% vs 8%, P=.002), known coronary artery disease (CAD; 22% vs 10%, P=.037), enlarged left ventricle (LV; 27% vs 9%, P=.002), LV wall-motion abnormality (33% vs 12%, P<.0001), enlarged aortic root (22% vs 8%, P=.009), or dilated left atrium (52% vs 30%, P=.002). Multivariate logistic regression analysis identified prior history of AF (OR=3.7, 95% CI 1.5-9.0, P=.005), larger LV size (OR=3.1, 95% CI 1.3-7.3, P=.009), and lower LV ejection fraction (OR=-0.95, 95% CI -0.92 to -0.99, P=.02) as independent predictors of AF during DSE. At a mean follow-up period of 3.4 (0.5-7.3)years, those with AF during DSE were more likely to develop new coronary events (22% vs 10%, P=.0372), new-onset heart failure (19% vs 4%, P=.0003), or die from any cause (27% vs 6%, P<.0001). Kaplan-Meier curves demonstrated significantly lower event-free survival in patients compared to controls (P by log-rank test=.001) over the follow-up period. Dobutamine-induced AF occurs more commonly in those with prior history of AF and remodeled LV and is associated with unfavorable outcomes.

Atrial Fibrillation on Admission Is Related With Higher Mortality in ST-Segment Elevation Myocardial Infarction Patients.

The prognostic significance of atrial fibrillation (AF) on mortality in ST-segment elevation myocardial infarction (STEMI) patients is not clearly understood. To elucidate the clinical significance of AF on mortality for 1 year in STEMI patients, we retrospectively analyzed the Korea Acute Myocardial Infarction Registry (KAMIR) database, which spans January 2008 to September 2010 and includes 14,329 patients with acute myocardial infarction. We selected 5,556 patients with marked ECG rhythm (NSR, normal sinus rhythm or AF) on emergency room arrival, < 12 hours of symptom onset, and who underwent primary percutaneous coronary intervention (PCI) within 90 minutes of arriving at the hospital. Patients who had been followed-up for at least for 1 year were analyzed (2,636 of NSR, 119 of AF). At enrollment, AF patients were older (70.7 versus 65.5 years, P < 0.001) and had lower systolic blood pressure (120.6 versus 125.9 mmHg, P = 0.050), a higher heart rate (80.4 versus 75.6/minute, P = 0.009), and a higher rate of Killip III, IV (25.0 versus 14.2%, P = 0.002). Patients with AF showed clearly higher all-cause mortality (22.7 versus 9.5%, HR 2.51, 95%CI 1.68~3.76, P < 0.001) and cardiac death rate (17.7 versus 7.5%, HR 2.49, 95%CI 1.59~3.90, P < 0.001) at 1 year after admission compared patients with NSR. AF induced significantly higher all-cause mortality and cardiac mortality rate in STEMI patients who were appropriately revascularized with primary PCI compared to NSR at 1 year.

The prognostic significance of atrial fibrillation in heart failure with preserved ejection function: insights from KaRen, a prospective and multicenter study.

The prognostic value of atrial fibrillation (AF) in heart failure with preserved ejection fraction (HFPEF) remains controversial. We sought to study the prognostic value of AF in a prospective cohort and to characterize the HFPEF patients with AF. KaRen was a prospective, multicenter, international, observational study intended to characterize HFPEF; 538 patients presenting with an acute decompensated cardiac failure and a left ventricular EF>45% were included. EKG and echocardiogram performed 4-8week following the index hospitalization were analyzed in core centers. Clinical and echocardiographic characteristics of patients in sinus rhythm vs. with documented AF at enrolment (decompensated HF), upon their 4-8-week visit (in presumed stable clinical condition) and according to patients' cardiac history, were compared. The primary study endpoint was death from any cause or first hospitalization for decompensated heart failure (HF). A total of 413 patients (32% in AF) were analyzed, with a mean follow-up period of 28months. The patients were primarily elderly individuals (mean age: 76.2years), with a slight female predominance and a high prevalence of non-cardiovascular comorbidities. The baseline echocardiographic characteristics and the natriuretic peptide levels were indicative of a more severe heart condition among the patients with AF. However, the patients with AF exhibited a similar survival-free interval compared with the patients in sinus rhythm. In this elderly HFPEF population with a high prevalence of non-cardiovascular comorbidities, the presence of AF was not associated with a worse prognosis despite impaired clinical and echocardiographic features.ClinicalTrials.gov: NCT00774709.

Prognostic Significance of Atrial Fibrillation in Lower Limb Amputee Patients

In patients with risk factors or established atherothrombosis, atrial fibrillation (AF) is associated with a poor prognosis compared with patients without AF. The aim of this study was to evaluate the prevalence of AF in patients with lower limb amputation (LLA) and its association with cardiovascular death and adverse cardiovascular events in long-term follow-up. Observational prospective study of consecutive patients after index major (transfemoral and transtibial) LLA. The primary endpoint was cardiovascular death and secondary endpoint was a composite of adverse cardiovascular events at follow-up (acute myocardial infarction, contralateral lower limb amputation, and ischaemic stroke). Of 282 patients with LLA, 46 (16.3%) patients had AF. AF patients were significantly older compared with patients without AF (median 74.0, IQR 13.0 vs. median 67.0, IQR 14.8 years, p< .001). Diabetes and smoking on the other hand were significantly less prevalent in patients with AF compared with those without AF (41.3% vs. 72.0%, p< .001 and 56.5% vs. 76.3%, p=.01, respectively). 54.3% of patients with AF were on oral anticoagulation therapy. At a median follow-up of 24.0 months (IQR 19.0-32.0), 28.3% patients with AF died of cardiovascular causes versus 17.8% without AF (HRR 1.8, 95% CI 1.0-3.4, p=.06). Adverse cardiovascular events occurred in 32.6% of patients with AF during follow-up versus 22.0% without AF (HRR 1.9, 95% CI 1.0-3.3, p=.03). In multivariate Cox regression analysis, AF (HRR 2.3, 95% CI 1.3-4.2, p=.01) and diabetes (HRR 2.1, 95% CI 1.1-3.9, p=.02) were identified as independent predictors of adverse cardiovascular events during the follow-up. AF is common in patients with LLA and associated with higher risk of adverse cardiovascular events during long-term follow-up.

Frequency of and Prognostic Significance of Atrial Fibrillation in Patients Undergoing Transcatheter Aortic Valve Implantation

The prognostic implications of preexisting atrial fibrillation (AF) and new-onset AF (NOAF) in transcatheter aortic valve implantation (TAVI) remain uncertain. This study assesses the epidemiology of AF in patients treated with TAVI and evaluates their outcomes according to the presence of preexisting AF or NOAF. A retrospective analysis of 708 patients undergoing TAVI from 2 heart hospitals was performed. Patients were divided into 3 study groups: sinus rhythm (n= 423), preexisting AF (n= 219), and NOAF (n= 66). Primary outcomes of interest were all-cause death and stroke both at 30-day and at 1-year follow-up. Preexisting AF was present in 30.9% of our study population, whereas NOAF was observed in 9.3% of patients after TAVI. AF and NOAF patients showed a higher rate of 1-year all-cause mortality compared with patients in sinus rhythm (14.6% vs 6.5% for preexisting AF and 16.3% vs 6.5% for NOAF, p= 0.007). No differences in 30-day mortality were observed between groups. In patients with AF (either preexisting and new-onset), those discharged with single antiplatelet therapy displayed higher mortality rates at 1 year (42.9% vs 11.7%, p= 0.006). Preexisting AF remained an independent predictor of mortality at 1-year follow-up (hazard ratio [HR] 2.34, 95% CI 1.22 to 4.48, p=0.010). Independent predictors of NOAF were transapical and transaortic approach as well as balloon postdilatation (HR 3.48, 95% CI 1.66 to 7.29, p= 0.001; HR 5.08, 95% CI 2.08 to 12.39, p <0.001; HR 2.76, 95% CI 1.25 to 6.08, p= 0.012, respectively). In conclusion, preexisting AF is common in patients undergoing TAVI and is associated with a twofold increased risk of 1-year mortality. This negative effect is most pronounced in patients discharged with single antiplatelet therapy compared with other antithrombotic regimens.

0370: The prognostic significance of atrial fibrillation in heart failure with preserved ejection function: insights from KaRen, a prospective and multicenter study

The prognostic value of atrial fibrillation (AF) in heart failure with preserved ejection fraction (HFPEF) remains controversial. The objective of the KaRen (Karolinska-Rennes) sub-study was to explore this question. KaRen was a prospective, multicenter, international, observational study intended to characterize HFPEF; 538 patients presenting acute decompensated cardiac failure with a left ventricular ejection fraction >45% were included. A physical exam as well as an EKG and an echocardiogram were scheduled 4-8 week following the index hospitalization, and the patients were evaluated at 6-month intervals. We compared clinical and echocardiographic characteristics of patients in sinus rhythm vs. patients with documented AF upon their 4-8-week visit. The primary study endpoint was death from any cause or first hospitalization for decompensated heart failure (HF). A total of 413 patients (244 patients in sinus rhythm and 134 in AF; 32% of overall population) were analyzed, with a mean follow-up period of 28 months. The patients were primarily elderly individuals (76.2 years), with a slight female predominance and a high prevalence of comorbidities. The baseline echo-cardiographic characteristics and the natriuretic peptide levels were indicative of a more severe heart condition among the patients with AF. However, the patients with AF exhibited a similar survival-free interval compared with the patients in sinus rhythm (p=0.89). Similar survival was observed according to patients’ heart rhythm on enrolment (decompensated HF) or according to patients’ cardiac history. Heart rate (stratified in tertiles), neurohormonal blockade or anticoagulant treatments at the 4-8-week visit were not independent predictors of outcome. In this HFPEF population with a high prevalence of non-cardiovascular comorbidities, the presence of AF was not associated with a poorer prognosis despite impaired clinical and echocardiographic features.

Atrial fibrillation and hypertrophic cardiomyopathy: who to anticoagulate?

Hypertrophic cardiomyopathy (HCM) is one of the most common genetic cardiac conditions. Atrial fibrillation (AF) has been demonstrated to be the most frequent arrhythmia encountered in HCM patients. Research focusing on AF and embolic stroke in HCM patients has been sparse and the sample size of most studies is small. The prognostic significance of AF in HCM patients is still not well known. The aim of this article is to provide further understanding of the anti-coagulation requirement of HCM patients with AF.