A meta-analysis of the impact of pre-existing and new-onset atrial fibrillation on clinical outcomes in patients undergoing transcatheter aortic valve implantation

Tools

Item Type:	Article
Title:	A meta-analysis of the impact of pre-existing and new-onset atrial fibrillation on clinical outcomes in patients undergoing transcatheter aortic valve implantation
Creators Name:	Sannino, A., Gargiulo, G., Schiattarella, G.G., Perrino, C., Stabile, E., Losi, M.A., Galderisi, M., Izzo, R., de Simone, G., Trimarco, B. and Esposito, G.
Abstract:	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.
Keywords:	Mortality, New-Onset Atrial Fibrillation, Pre-Existing Atrial Fibrillation, Severe Aortic Stenosis, Transcatheter Aortic Valve Implantation
Source:	EuroIntervention
ISSN:	1774-024X
Publisher:	Europa Group
Volume:	12
Number:	8
Page Range:	e1047-e1056
Date:	10 October 2016
Official Publication:	https://doi.org/10.4244/EIJY15M11_12
PubMed:	View item in PubMed

Repository Staff Only: item control page