Conclusions Systematic identification of new-onset arrhythmias following TAVI may have considerable impact on subsequent therapeutic management and long-term prognosis in this patient population
Objective To evaluate the prevalence and clinical impact of new-onset arrhythmias in patients following transcatheter aortic valve implantation ( TAVI ) .
Atrial Fibrillation and Aortic Stenosis: Impact on Clinical Outcomes Among Patients Undergoing Transcatheter Aortic Valve Implantation
Background —Atrial fibrillation ( AF ) is an important risk factor for stroke and is common among elderly patients undergoing transcatheter aortic valve implantation .  The aim of this study was to assess the impact of AF on clinical outcomes among patients undergoing transcatheter aortic valve implantation .  Methods and Results —Between August 2007 and October 2011 , a total of 389 high-risk patients undergoing transcatheter aortic valve implantation  were included into a prospect i ve registry . AF was recorded in 131 patients ( 33.7 % ) with a mean CHA2DS2–VASC score of 4.5±1.2 and was paroxysmal in 26 ( 25.0 % ) , persistent in 8 ( 7.7 % ) , and permanent in 70 patients ( 67.3 % ) . Patients with and without AF had similar baseline characteristics except for fewer revascularization procedures ( coronary artery bypass grafting : 12 % versus 22 % ; P=0.03 ) among AF patients . At 1 year , all-cause mortality was higher among patients with AF ( 30.9 % ) compared with those without AF ( 13.9 % ; hazard ratio [ HR ] , 2.36 ; 95 % confidence interval [ CI ] , 1.43–3.90 ; P=0.0008 ) . This was observed irrespective of the type of AF ( permanent , HR , 2.47 ; 95 % CI , 1.40–4.38 ; persistent , HR , 3.60 ; 95 % CI , 1.10–11.78 ; paroxysmal , HR , 2.88 ; 95 % CI , 1.37–6.05 ) . Mortality gradually increased with higher CHA2DS2–VASC scores ( score 1–3 : HR , 2.20 ; 95 % CI , 0.92–5.27 ; score 6–8 : HR , 4.12 ; 95 % CI , 2.07–8.20 ) . The risks of stroke ( 3.9 % versus 5.1 % ; HR , 0.76 ; 95 % CI , 0.23–1.96 ; P=0.47 ) and life-threatening bleeding ( 19.8 % versus 14.7 % ; HR , 1.37 ; 95 % CI , 0.86–2.19 ; P=0.19 ) were similar among patients with and without AF . Conclusions —AF is common among high-risk patients with severe aortic stenosis undergoing transcatheter aortic valve implantation and is associated with a > 2-fold increased risk of all-cause and cardiovascular mortality , irrespective of the type of AF . The gradient of risk directly correlates with the CHA2DS2–VASC score
Conclusions Systematic identification of new-onset arrhythmias following TAVI may have considerable impact on subsequent therapeutic management and long-term prognosis in this patient population
Objective To evaluate the prevalence and clinical impact of new-onset arrhythmias in patients following transcatheter aortic valve implantation ( TAVI ) .