TY - JOUR
T1 - New-onset atrial fibrillation after aortic valve replacement
T2 - Comparison of transfemoral, transapical, transaortic, and surgical approaches
AU - Tanawuttiwat, Tanyanan
AU - O'Neill, Brian P.
AU - Cohen, Mauricio G.
AU - Chinthakanan, Orawee
AU - Heldman, Alan W.
AU - Martinez, Claudia A.
AU - Alfonso, Carlos E.
AU - Mitrani, Raul D.
AU - Macon, Conrad J.
AU - Carrillo, Roger G.
AU - Williams, Donald B.
AU - O'Neill, William W.
AU - Myerburg, Robert J.
PY - 2014/4/22
Y1 - 2014/4/22
N2 - Objectives: This study sought to determine the incidence of new-onset atrial fibrillation (AF) associated with different methods of isolated aortic valve replacement (AVR) - transfemoral (TF), transapical (TA), and transaortic (TAo) catheter-based valve replacement and conventional surgical approaches. Background: The relative incidences of AF associated with the various access routes for AVR have not been well characterized. Methods: In this single-center, retrospective cohort study, we evaluated a total of 231 consecutive patients who underwent AVR for degenerative aortic stenosis (AS) between March 2010 and September 2012. Patients with a history of paroxysmal, persistent, or chronic AF, with bicuspid aortic valves, and patients who died within 48 h after AVR were excluded. A total of 123 patients (53% of total group) qualified for inclusion. Data on documented episodes of new-onset AF, along with all clinical, echocardiographic, procedural, and 30-day follow-up data, were collated. Results: AF occurred in 52 patients (42.3%). AF incidence varied according to the procedural method. AF occurred in 60% of patients who underwent surgical AVR (SAVR), in 53% after TA-TAVR, in 33% after TAo-TAVR cases, and 14% after TF-TAVR. The episodes occurred at a median time interval of 53 (25th to 75th percentile, 41 to 87) h after completion of the procedure. Procedures without pericardiotomy had an 82% risk reduction of AF compared with those with pericardiotomy (adjusted odds ratio: 0.18; 95% confidence interval: 0.05 to 0.59). Conclusions: AF was a common complication of AVR with a cumulative incidence of >40% in elderly patients with degenerative AS who underwent either SAVR or TAVR. AF was most common with SAVR and least common with TF-TAVR. Procedures without pericardiotomy were associated with a lower incidence of AF.
AB - Objectives: This study sought to determine the incidence of new-onset atrial fibrillation (AF) associated with different methods of isolated aortic valve replacement (AVR) - transfemoral (TF), transapical (TA), and transaortic (TAo) catheter-based valve replacement and conventional surgical approaches. Background: The relative incidences of AF associated with the various access routes for AVR have not been well characterized. Methods: In this single-center, retrospective cohort study, we evaluated a total of 231 consecutive patients who underwent AVR for degenerative aortic stenosis (AS) between March 2010 and September 2012. Patients with a history of paroxysmal, persistent, or chronic AF, with bicuspid aortic valves, and patients who died within 48 h after AVR were excluded. A total of 123 patients (53% of total group) qualified for inclusion. Data on documented episodes of new-onset AF, along with all clinical, echocardiographic, procedural, and 30-day follow-up data, were collated. Results: AF occurred in 52 patients (42.3%). AF incidence varied according to the procedural method. AF occurred in 60% of patients who underwent surgical AVR (SAVR), in 53% after TA-TAVR, in 33% after TAo-TAVR cases, and 14% after TF-TAVR. The episodes occurred at a median time interval of 53 (25th to 75th percentile, 41 to 87) h after completion of the procedure. Procedures without pericardiotomy had an 82% risk reduction of AF compared with those with pericardiotomy (adjusted odds ratio: 0.18; 95% confidence interval: 0.05 to 0.59). Conclusions: AF was a common complication of AVR with a cumulative incidence of >40% in elderly patients with degenerative AS who underwent either SAVR or TAVR. AF was most common with SAVR and least common with TF-TAVR. Procedures without pericardiotomy were associated with a lower incidence of AF.
KW - atrial fibrillation
KW - transcatheter aortic valve replacement
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UR - http://www.scopus.com/inward/citedby.url?scp=84902096270&partnerID=8YFLogxK
U2 - 10.1016/j.jacc.2013.11.046
DO - 10.1016/j.jacc.2013.11.046
M3 - Article
C2 - 24486264
AN - SCOPUS:84902096270
SN - 0735-1097
VL - 63
SP - 1510
EP - 1519
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 15
ER -