Pre-existing AF increased long-term all-cause mortality (HR 1.68, p<0.00001), while new-onset AF increased short-term cerebrovascular events (HR 2.86, p<0.00001) in patients undergoing TAVI.
Meta-Analysis (n=14,078)
Does pre-existing or new-onset atrial fibrillation worsen clinical outcomes in patients undergoing transcatheter aortic valve implantation compared to sinus rhythm?
Pre-existing AF predicts long-term all-cause mortality, while new-onset AF is associated with increased short-term cerebrovascular events in patients undergoing TAVI.
Hazard Ratio: 1.68
p-value: p=<0.00001
AIMS: Little is known about the prognostic role of pre-existing atrial fibrillation (AF) and new-onset AF (NOAF) in transcatheter aortic valve implantation (TAVI). Therefore, the aim of this meta-analysis was to compare the short- and long-term clinical outcomes of patients undergoing TAVI with and without pre-existing and new-onset AF. METHODS AND RESULTS: Twenty-six studies, enrolling 14,078 patients undergoing TAVI, of whom 33.4% had pre-existing AF and 17.5% had NOAF, were analysed for early and long-term all-cause mortality, cardiovascular mortality and cerebrovascular events (CVE). In patients with pre-existing AF, 30-day all-cause mortality was similar to patients in sinus rhythm (SR). Conversely, long-term all-cause and cardiovascular mortality were significantly greater in pre-existing AF patients than in patients with SR (20 studies; 8,743 patients; HR: 1.68; p<0.00001, and three studies; 1,138 patients; HR: 2.07; p=0.01, respectively). Pre-existing AF was not a predictor of CVE at long-term follow-up. NOAF patients showed similar short- and long-term all-cause mortality when compared to patients in SR, whereas they experienced a significantly higher incidence of CVE at short-term follow-up (six studies; 2,025 patients; HR: 2.86; p<0.00001). A non-significant increase in the incidence of CVE was observed at long-term follow-up. CONCLUSIONS: Pre-existing AF is a predictor of all-cause mortality in patients undergoing TAVI. NOAF is related to the occurrence of CVE at short-term follow-up. Similarly to surgical aortic valve replacement (SAVR), the optimal management and risk stratification of these patients should be further investigated.
Sannino et al. (Sat,) conducted a meta-analysis in transcatheter aortic valve implantation (TAVI) (n=14,078). Pre-existing and new-onset atrial fibrillation vs. Sinus rhythm was evaluated on long-term all-cause mortality (HR 1.68, p=<0.00001). Pre-existing AF increased long-term all-cause mortality (HR 1.68, p<0.00001), while new-onset AF increased short-term cerebrovascular events (HR 2.86, p<0.00001) in patients undergoing TAVI.