Differences in cardiac output of patients undergoing trans-catheter aortic valve implantation according to their underlying rhythm

BACKGROUND The recent Cardiac Output in Patients with Small Annuli Undergoing Transcatheter Aortic Valve Implantation with Self-Expanding vs Balloon Expandable Valve (COPS-TAVI) study provided some insights into the differences in cardiac output in patients with small aortic annuli undergoing transcatheter aortic valve implantation (TAVI) according to the implanted platform: Balloon-expandable (BEV) vs self-expanding valves (SEV). AIM To investigate the understudied role of atrial fibrillation (AF) on cardiac output in patients undergoing TAVI. METHODS The COPS-TAVI study enrolled consecutive patients with severe aortic stenosis and small annuli who underwent successful TAVI. Cardiac output was measured using echocardiography within 4 weeks following TAVI. Data were analyzed according to the presence of AF and stratified by SEV or BEV. RESULTS A total of 138 patients were included in the analysis, of whom 22% had AF. Cardiac output was significantly lower in patients with AF compared to those without it (4.6 L/minute vs 5.3 L/minute, P = 0.02). Consistent with the main study findings, the difference in cardiac output was evident among patients without AF who underwent SEV vs BEV (P < 0.05). On the other hand, there was no difference in cardiac output in patients with AF, irrespective of the implanted platform (P > 0.05). There was no difference in clinical outcomes between the two groups. CONCLUSION Cardiac output, as measured by echocardiography, was larger in patients with small annuli who underwent TAVI procedure with SEV compared to BEV in patients without AF. This observation should be considered during procedural planning.