What is the clinical evidence from this study?

Study design: Cohort. Population: Aortic stenosis post-TAVR with preserved ejection fraction (n=947). Intervention: Atrial fibrillation vs. Sinus rhythm. Primary outcome: Survival (HR 1.611, 95% CI 1.248-2.080, p=<0.001).

What does this research mean for the field?

Atrial fibrillation after TAVR with preserved ejection fraction is associated with a 61% increased mortality risk compared to patients in sinus rhythm (HR 1.611). Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.CHALLENGES_CONSENSUS.

What question did this study set out to answer?

This research aims to evaluate the impact of atrial fibrillation on survival outcomes in patients with preserved ejection fraction after undergoing TAVR.

February 2, 2026European Heart Journal - Cardiovascular Imaging

Prognostic impact of atrial fibrillation in post-TAVR patients with preserved ejection fraction

Q: What are the key findings of this study?

Atrial fibrillation was associated with worse survival compared to sinus rhythm in patients with preserved ejection fraction after TAVR (adjusted HR 1.611; 95% CI 1.248-2.080; P<0.001).

Q: What does this research mean for the field?

Atrial fibrillation after TAVR with preserved ejection fraction is associated with a 61% increased mortality risk compared to patients in sinus rhythm (HR 1.611). Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.CHALLENGES_CONSENSUS.

Q: What question did this study set out to answer?

This research aims to evaluate the impact of atrial fibrillation on survival outcomes in patients with preserved ejection fraction after undergoing TAVR.

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Key result

Post-TAVR AF with preserved EF is linked to ~61% higher mortality versus sinus rhythm.

HR 1.611
95% CI 1.248-2.080
P<0.001
n=947

Why the study?

The impact of atrial fibrillation on mortality after TAVR is controversial in patients with preserved ejection fraction.

Does atrial fibrillation increase all-cause mortality in post-TAVR patients with preserved ejection fraction compared to sinus rhythm?

Key Points

This research aims to evaluate the impact of atrial fibrillation on survival outcomes in patients with preserved ejection fraction after undergoing TAVR.
Retrospective study involving patients with preserved ejection fraction (≥ 50%) who underwent TAVR.
Data collected from a tertiary cardiovascular center between January 2020 and September 2024.
All-cause mortality was assessed with a median follow-up of 17.5 months.
A total of 947 patients with preserved EF were analyzed, with 348 having atrial fibrillation.
Kaplan-Meier analysis indicated 79.6% survival in sinus rhythm patients versus 65.2% in those with atrial fibrillation (p<0.001).
Atrial fibrillation was identified as an independent predictor of mortality with a hazard ratio of 1.611 (p<0.001).

Study Design

Type

Cohort (n=947)

Multicenter

Structured PICO

Does atrial fibrillation increase all-cause mortality in post-TAVR patients with preserved ejection fraction compared to sinus rhythm?

Population

947 patients with preserved ejection fraction (≥50%) who underwent TAVR, followed for a median of 17.5 months to assess the prognostic impact of atrial fibrillation.

Exposure

Atrial fibrillation (AF)

Comparator

Sinus rhythm (SR)

Outcome

All-cause mortalityhard clinical

Main Result

Hazard Ratio: 1.611 (95% CI 1.248–2.08)

Absolute Event Rate: 65.2% vs 79.6%

p-value: p=<0.001

In post-TAVR patients with preserved ejection fraction, the presence of atrial fibrillation is an independent predictor of increased all-cause mortality.

Implication

AF signals higher post-TAVR mortality risk in preserved EF; hypothesis-generating for rhythm intervention trials.

Abstract

Background Aortic stenosis (AS) is the most common valvular heart disease in the elderly and often associated with atrial fibrillation (AF). The impact of AF on mortality is controversial in patients with preserved ejection fraction (EF) after transcatheter aortic valve replacement (TAVR). Aims Our aim was to assess the impact of AF on survival in patients after TAVR with preserved EF in comparison with patients with sinus rhythm (SR), and to evaluate prognostic factors in AF patients. Methods In our retrospective study we enrolled patients with preserved EF ( ≥ 50%) who underwent TAVR in our tertiary cardiovascular center between 01.01.2020-01.09.2024. All-cause mortality was assessed, with a median follow-up of 17.5 months (IQR: 7.5 - 30.2 months). Results During the observed period 1511 patients underwent TAVR, of whom 947 had preserved EF. In the AF group (n= 348) patients were older (80.4±5.5 yrs vs 79.63±5.6 yrs, p=0.03) but the proportion of male sex (43% vs 39%; p=0.27) did not differ from patients with SR (n=599). There was no difference in EF (63.3±7.6% vs 64.1±7.7%, p=0.11), but the rate of paradoxical low-flow (SVi <35 ml/m2) and low-gradient (mean gradient <40 mmHg) AS was more prevalent in patients with AF (49% vs 36%; p<0.0001), and Doppler index (DI) was significantly lower (0.19±0.05 vs 0.21 ± 0.05; p=0.001) compared to patients with SR. Patients with AF had larger right atrium (RAVi: 35.9 ± 26.2 ml/m2 vs 23.3 ± 10.4 ml/m2; p<0.001) and right ventricle (RV mid diameter: 33.0 ± 6.5 mm vs 30.6 vs 5.2 mm; p<0.001), and worse right ventricular systolic function (TAPSE: 20.9±12.8 mm vs 22.6±4.3 mm; p<0.01; RV S’: 11.4±2.5 cm/s vs 12.4±2.8 cm/s; p<0.001). Kaplan-Meier analysis showed better survival in patients with SR than in patients with AF (79.6% vs. 65.2%, log-rank <0.001). Considering the whole group in univariate Cox proportional hazard model EF, aortic Vmax, aortic mean gradient, AVA had no effect on survival, while age (HR: 1.030 [CI: 1.007-1.054], p=0.01), male sex (HR: 1.317 [CI: 1.023-1.695], p=0.03), AF (HR: 1.705 [CI: 1.325-2.193], p<0.001), SVi (HR: 0.984 [CI: 0.970-0.998], p=0.023), and DI (HR: 0.036 [CI: 0.002-0.540], p=0.016) were significant predictors, of which only age (HR: 1.026 [CI: 1.003-1-050], p=0.025) male sex (HR: 1.140 [CI: 1.005-1.294], p=0.041), and AF (HR: 1.611 [CI: 1.248-2.080], p<0.001) remained independent predictors in a multivariate model. Subgroup analysis of patients with AF showed that only male sex (HR: 1.443 [CI: 1.006-2.075], p<0.05) and SVi (HR: 0.974 [CI: 0.951-0.997], p<0.05) was an independent predictor for outcome. Conclusions Patients after TAVR with preserved ejection fraction and atrial fibrillation had worse outcome than those in sinus rhythm. Atrial fibrillation, stroke voulume index and male sex was found to be an independent predictor of mortality.Kaplan-Meier survival curve

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Cite This Study

Dénes et al. (2026) conducted a cohort in Aortic stenosis post-TAVR with preserved ejection fraction (n=947). Atrial fibrillation vs. Sinus rhythm was evaluated on Survival (HR 1.611, 95% CI 1.248-2.080, p=<0.001). Atrial fibrillation was associated with worse survival compared to sinus rhythm in patients with preserved ejection fraction after TAVR (adjusted HR 1.611; 95% CI 1.248-2.080; P<0.001).

synapsesocial.com/papers/6980fe48c1c9540dea810322 https://doi.org/10.1093/ehjci/jeaf367.202