1Universitätsklinikum Würzburg Medizinische Klinik und Poliklinik I Würzburg, Deutschland
Background
Atrial fibrillation (AF) is linked to adverse outcomes following transcatheter aortic valve implantation (TAVI). This study aimed to assess the prognostic implications for the two-year outcome of TAVI patients with two distinct categories of AF: history of persistent AF more than one year and history of paroxysmal or persistent AF less than one year.
Methods
We conducted a screening among 1275 aortic stenosis patients who underwent TAVI at our hospital between July 2009 and December 2021. AF patients were identified based on their medical history and the findings of 24-hour ECG recording within 7 days after TAVI. Patients were categorized into three groups: “no AF” group (n=683, mean age 81.0±6.2 years, 50.1% male); the “<1 year AF” group (patients with paroxysmal or persistent AF history less than one year, n=132, mean age 82.1±4.8 years, 48.5% male); the “>1 year AF” group (patients with persistent AF history more than one year, n=460, mean age 81.8±4.6 years, 55.1% male). Two-year all-cause mortality and cardiovascular (CV) mortality after TAVI were compared among these groups.
Results
TAVI patients in the “>1 year AF” group exhibited the highest two-year all-cause mortality and CV mortality rates, significantly higher than patients in the “no AF” group or the “<1 year AF” group (all-cause mortality: 24.6% vs. 12.6% vs. 13.6%, P<0.001; CV mortality 18.9% vs. 8.1% vs. 6.8%, P<0.001). Mortality rates were comparable between the “no AF” group and the “<1 year AF” group.
TAVI patients in the “>1 year AF” group were characterized by higher EuroSCORE II score, lower prevalence of hyperlipidaemia, higher proportion of hyperuricemia, stroke or TIA, and chronic kidney insufficiency compared with patients in the “no-AF” group.
EuroSCORE II (HR=1.031, 95% CI 1.004-1.058, P=0.024) and the presence of anemia (HR=2.274, 95% CI 1.433-3.607, P<0.001) were identified as independent risk factors associated with an increased two-year all-cause mortality risk in TAVI patients in the “> 1 year AF” group. Among patients in the “>1 year AF” group, older age (HR=1.053, 95% CI 1.003-1.105, P=0.038) and the presence of anemia (HR 2.491, 95% CI 1.464-4.237) were identified as independent risk factors associated with an increased two-year CV mortality risk.
Conclusions
Patients undergoing with history of AF more than one year face a higher two-year mortality risk compared to patients without AF or less than one year AF history. For this high-risk group, EuroSCORE II and anemia are identified as independent risk factors contributing to the increased mortality risk.