What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: Aortic stenosis (n=158220). Intervention: New-onset atrial fibrillation vs. Sinus rhythm. Primary outcome: 30-day mortality (OR 3.18, 95% CI 1.58, 6.40, p=0.001).

January 17, 2022Open Access

Impact of new-onset versus pre-existing atrial fibrillation on outcomes after transcatheter aortic valve replacement/implantation

NNNso NsoInterventional / Structural Cardiology KEKelechi EmmanuelUPMC Central Pa MNMahmoud NassarUniversity of Vermont

Key Result

New-onset atrial fibrillation after transcatheter aortic valve replacement was associated with a significantly higher risk of 30-day mortality compared to sinus rhythm (OR 3.18).

Study Design

Type

Meta-Analysis (n=158,220)

Structured PICO

Does new-onset or pre-existing atrial fibrillation increase the risk of adverse clinical outcomes in adult patients undergoing TAVR/TAVI compared to sinus rhythm?

Population

158,220 adult patients with aortic stenosis undergoing transcatheter aortic valve replacement or implantation, evaluated for the impact of new-onset or pre-existing atrial fibrillation on clinical outcomes.

Exposure

New-onset atrial fibrillation (NOAF) or pre-existing atrial fibrillation (pre-AF) post-operatively.

Comparator

Patients in sinus rhythm after TAVR/TAVI.

Outcome

30-day mortality, stroke, acute kidney injury (AKI), length of stay (LOS), early bleeding, and late bleeding.hard clinical

New-onset atrial fibrillation after TAVR/TAVI is significantly associated with increased 30-day mortality, stroke, acute kidney injury, and extended length of stay compared to patients in sinus rhythm.

Main Result

Odds Ratio: 3.18 (95% CI 1.58–6.4)

p-value: p=0.001

Limitations

The role of mechanical complications and their impact on atrial fibrillation and its clinical complications after TAVI was not assessed.
The obtained results do not delineate the causative factors contributing to the progression of new-onset atrial fibrillation.
The inclusion of retrospective and prospective studies restricts the validity, reliability, and generalizability of the outcomes due to the unavailability of randomized controlled trials.

Abstract

Patients with aortic stenosis who undergo transcatheter aortic valve replacement/transcatheter aortic valve implantation (TAVR/TAVI) experience a high incidence of pre-existing atrial fibrillation (pre-AF) and new-onset atrial fibrillation (NOAF) post-operatively. This systematic review and meta-analysis aimed to update current evidence concerning the incidence of 30-day mortality, stroke, acute kidney injury (AKI), length of stay (LOS), and early/late bleeding in patients with NOAF or pre-AF who undergo TAVR/TAVI. PubMed, Google Scholar, JSTOR, Cochrane Library, and Web of Science were searched for studies published between January 2012 and December 2020 reporting the association between NOAF/pre-AF and clinical complications after TAVR/TAVI. A total of 15 studies including 158,220 adult patients with TAVI/TAVR and NOAF or pre-AF were identified. Compared to patients in sinus rhythm, patients who developed NOAF had a higher risk of 30-day mortality, AKI, early bleeding events, extended LOS, and stroke after TAVR/TAVI (odds ratio OR: 3.18 95% confidence interval [CI 1.58, 6.40]) (OR: 3.83 95% CI 1.18, 12.42) (OR: 1.70 95% CI 1.05, 2.74) (OR: 13.96 95% CI, 6.41, 30.40) (OR: 2.51 95% CI 1.59, 3.97, respectively). Compared to patients in sinus rhythm, patients with pre-AF had a higher risk of AKI and early bleeding episodes after TAVR/TAVI (OR: 2.43 95% CI 1.10, 5.35) (OR: 17.41 95% CI 6.49, 46.68, respectively). Atrial fibrillation is associated with a higher risk of all primary and secondary outcomes. Specifically, NOAF but not pre-AF is associated with a higher risk of 30-day mortality, stroke, and extended LOS after TAVR/TAVI.

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