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Prognostic impact of atrial fibrillation in patients undergoing transcatheter aortic valve implantation

https://doi.org/10.1007/s00392-025-02625-4

Jakob Johannes Reichl (Basel)1, T. Stolte (Basel)1, J. Boeddinghaus (Basel)1, M. Wagener (Basel)1, G. Leibundgut (Basel)1, P. Badertscher (Basel)1, C. Sticherling (Basel)1, M. Kühne (Basel)1, C. A. Kaiser (Basel)1, F. Mahfoud (Basel)1, T. Nestelberger (Basel)1

1Universitätsspital Basel Abt. für Kardiologie Basel, Schweiz

 

Background: Atrial fibrillation (AF) is the most common arrhythmia and an important risk factor for adverse cardiac outcomes, including heart failure and stroke. Moreover, AF has been linked to worse outcomes following transcatheter aortic valve implantation (TAVI). Real-world data on the impact of AF on outcomes after TAVI remain limited. 

Aims: To assess the impact of AF on periprocedural and short-term outcomes after TAVI. 

Methods: Patients undergoing TAVI at a tertiary center were consecutively included in a prospective registry. Cardiac rhythm at baseline was assessed using 12-lead ECGs. The primary outcome was all-cause mortality at 30 days. Secondary outcomes included all-cause mortality at one year, stroke at 30 days and one year, and procedural success, defined as freedom from periprocedural mortality, surgical re-interventions, re-interventions of the aortic valve, major access site complications, and periprocedural bleedings until discharge.

Results: Among 1655 patients undergoing TAVI, 428 patients (25.6%) had pre-existing AF, while 77 patients (4.6%) were diagnosed with new-onset AF during hospitalization for TAVI. AF was associated with higher mortality at both, 30 days (3.7% vs. 2.0%, p=0.046, HR 1.8 (95%CI 1.0-3.3)) and one year (13.8% vs. 8.4%, p<0.001, HR 1.7 (95%CI 1.2 – 2.3)). The stroke rate was higher in patients with AF at 30 days (5.9% vs. 2.7%, p=0.001, HR 2.1 (95%CI 1.3 – 3.6)) and at one year (7.1% vs. 3.8%, p=0.001, HR 1.9 (95%CI 1.2 – 3.0)). At discharge, 452 patients (89.5%) with AF received oral anticoagulation. After adjusting for anticoagulant therapy, the difference in stroke risk at 30 days (5.7% vs. 2.3%, p=0.058) and one year (6.8% vs. 4.2%, p=0.165) was no longer significant. Patients with AF experienced more major or life-threatening bleeding complications (14.2% vs. 10.6%, p=0.043). There were no differences in procedural success between patients with and without AF (78.8% vs. 78.3%, p=0.886). 

Conclusion: AF was associated with higher rates of mortality, stroke, and major bleedings at 30 days and one year after TAVI. 

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