Nonparoxysmal atrial fibrillation was associated with a significantly increased risk of stroke or death (HR 2.76) compared with sinus rhythm in patients undergoing TAVR.
Cohort (n=319)
No
Does the clinical type of atrial fibrillation (paroxysmal vs nonparoxysmal) affect the risk of stroke or death in patients undergoing TAVR?
In patients undergoing TAVR, a history of nonparoxysmal AF, but not paroxysmal AF, is associated with a significantly increased risk of stroke or death at 2 years compared to sinus rhythm.
Effect estimate: HR 2.76 (95% CI 1.63-4.66)
Absolute Event Rate: 38% vs 16%
p-value: p=<0.001
BACKGROUND: There are limited data available regarding the relationship between atrial fibrillation (AF) clinical type, oral anticoagulation (OAC) treatment, and clinical outcome after transcatheter aortic valve replacement (TAVR). The study was designed to evaluate this relationship. METHODS: We analyzed data from the Rabin Medical Center TAVR registry, including 319 consecutive patients who underwent TAVR from 2008 to 2014. Patients were divided into three groups based on their history of AF: sinus rhythm (SR), paroxysmal AF (PAF), or nonparoxysmal AF (NPAF). RESULTS: There were 211 (66%), 56 (18%), and 52 (16%) patients in the SR, PAF, and NPAF groups, respectively. The cumulative risk for stroke or death at 2 years was highest among patients with NPAF (38%), but similarly low in PAF (15%) and SR patients (16%, P < 0.001). By multivariate analysis, patients with NPAF demonstrated a significantly higher risk of stroke or death (HR = 2.76, 95% CI 1.63-4.66, P < 0.001), as compared with SR. In contrast, patients with PAF had a similar risk of stroke or death compared with SR (HR = 0.80, P = 0.508). Patients with NPAF not treated with OAC demonstrated an 8.3-fold (P < 0.001) increased risk of stroke or death, whereas patients with PAF not treated with OAC had a similar risk of stroke or death compared with the SR group (HR = 1.25, P = 0.569). CONCLUSION: History of NPAF, but not PAF, is associated with a significant increased risk of stroke or death compared with sinus rhythm in patients undergoing TAVR.
Shaul et al. (2016) conducted a cohort in Severe symptomatic aortic stenosis (n=319). Nonparoxysmal atrial fibrillation (NPAF) vs. Sinus rhythm (SR) was evaluated on Composite of stroke and all-cause death (HR 2.76, 95% CI 1.63-4.66, p=<0.001). Nonparoxysmal atrial fibrillation was associated with a significantly increased risk of stroke or death (HR 2.76) compared with sinus rhythm in patients undergoing TAVR.