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Incidence, Management, and Associated Clinical Outcomes of New-Onset Atrial Fibrillation Following Transcatheter Aortic Valve Replacement: An Analysis From the STS/ACC TVT Registry.

Publication ,  Journal Article
Vora, AN; Dai, D; Matsuoka, R; Harrison, JK; Hughes, GC; Sherwood, MW; Piccini, JP; Bhardwaj, B; Lopes, RD; Cohen, D; Holmes, DR; Thourani, VH ...
Published in: JACC Cardiovasc Interv
September 10, 2018

OBJECTIVES: The aim of this study was to evaluate incidence, care patterns, and clinical outcomes in patients developing new-onset atrial fibrillation (AF) following transcatheter aortic valve replacement (TAVR). BACKGROUND: Pre-procedural AF has been associated with adverse outcomes in patients undergoing TAVR, but the incidence of new-onset AF, associated anticoagulant management, and subsequent clinical outcomes are unclear. METHODS: Using the Society of Thoracic Surgeons/American College of Cardiology TVT (Transcatheter Valve Therapy) Registry linked with Medicare claims, patients undergoing TAVR from 2011 to 2015 who developed post-procedural AF were evaluated. Patients with known AF prior to TAVR were excluded. Outcomes of interest included in-hospital mortality and stroke and all-cause mortality, stroke, and bleeding at 12 months. Multivariate adjustment was then performed to determine differences in 1-year outcomes among those with and without new post-procedural AF, stratified by anticoagulation status. RESULTS: We identified 1,138 of 13,556 patients (8.4%) who developed new onset AF (4.4% of transfemoral [TF]-access patients, 16.5% of non-TF-access patients). Patients developing AF were older, more likely female, had higher Society of Thoracic Surgeons risk scores, and were often treated using non-TF access. Despite having a median CHA2DS2-VASc score of 5 (25th and 75th percentile: 5 to 6), only 28.9% of patients with new AF were discharged on oral anticoagulation. In-hospital mortality (7.8% vs. 3.4%; p < 0.01) and stroke (4.7% vs. 2.0%; p < 0.01) were higher among patients who developed post-procedural AF compared with those who did not. At 1 year, rates of death (adjusted hazard ratio [HR]: 1.37; 95% confidence interval [CI]: 1.19 to 1.59), stroke (adjusted HR: 1.50; 95% CI: 1.14 to 1.98), and bleeding (adjusted HR: 1.24; 95% CI: 1.10 to 1.40) were higher among patients with new-onset AF. One-year mortality rates were highest among patients who developed new-onset AF but were not discharged on anticoagulation. CONCLUSIONS: Post-TAVR AF occurred in 8.4% of patients (4.4% with TF access, 16.5% with non-TF access), with fewer than one-third of patients receiving anticoagulation at discharge, and was associated with increased risk for in-hospital and 1-year mortality and stroke. Given the clinical significance of post-TAVR AF, additional studies are necessary to delineate the optimal management strategy in this high-risk population.

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Published In

JACC Cardiovasc Interv

DOI

EISSN

1876-7605

Publication Date

September 10, 2018

Volume

11

Issue

17

Start / End Page

1746 / 1756

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Transcatheter Aortic Valve Replacement
  • Time Factors
  • Stroke
  • Risk Factors
  • Risk Assessment
  • Registries
  • Male
  • Incidence
 

Citation

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Chicago
ICMJE
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Vora, A. N., Dai, D., Matsuoka, R., Harrison, J. K., Hughes, G. C., Sherwood, M. W., … Vemulapalli, S. (2018). Incidence, Management, and Associated Clinical Outcomes of New-Onset Atrial Fibrillation Following Transcatheter Aortic Valve Replacement: An Analysis From the STS/ACC TVT Registry. JACC Cardiovasc Interv, 11(17), 1746–1756. https://doi.org/10.1016/j.jcin.2018.05.042
Vora, Amit N., Dadi Dai, Roland Matsuoka, J Kevin Harrison, G Chad Hughes, Matthew W. Sherwood, Jonathan P. Piccini, et al. “Incidence, Management, and Associated Clinical Outcomes of New-Onset Atrial Fibrillation Following Transcatheter Aortic Valve Replacement: An Analysis From the STS/ACC TVT Registry.JACC Cardiovasc Interv 11, no. 17 (September 10, 2018): 1746–56. https://doi.org/10.1016/j.jcin.2018.05.042.
Vora AN, Dai D, Matsuoka R, Harrison JK, Hughes GC, Sherwood MW, et al. Incidence, Management, and Associated Clinical Outcomes of New-Onset Atrial Fibrillation Following Transcatheter Aortic Valve Replacement: An Analysis From the STS/ACC TVT Registry. JACC Cardiovasc Interv. 2018 Sep 10;11(17):1746–56.
Vora, Amit N., et al. “Incidence, Management, and Associated Clinical Outcomes of New-Onset Atrial Fibrillation Following Transcatheter Aortic Valve Replacement: An Analysis From the STS/ACC TVT Registry.JACC Cardiovasc Interv, vol. 11, no. 17, Sept. 2018, pp. 1746–56. Pubmed, doi:10.1016/j.jcin.2018.05.042.
Vora AN, Dai D, Matsuoka R, Harrison JK, Hughes GC, Sherwood MW, Piccini JP, Bhardwaj B, Lopes RD, Cohen D, Holmes DR, Thourani VH, Peterson E, Kirtane A, Kapadia S, Vemulapalli S. Incidence, Management, and Associated Clinical Outcomes of New-Onset Atrial Fibrillation Following Transcatheter Aortic Valve Replacement: An Analysis From the STS/ACC TVT Registry. JACC Cardiovasc Interv. 2018 Sep 10;11(17):1746–1756.
Journal cover image

Published In

JACC Cardiovasc Interv

DOI

EISSN

1876-7605

Publication Date

September 10, 2018

Volume

11

Issue

17

Start / End Page

1746 / 1756

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Transcatheter Aortic Valve Replacement
  • Time Factors
  • Stroke
  • Risk Factors
  • Risk Assessment
  • Registries
  • Male
  • Incidence