Impact of Atrial Fibrillation Type on Outcomes of Transcatheter Aortic Valve Replacement for Aortic Stenosis: A Single-Center Analysis
Background: Atrial fibrillation (AF) is a recognized risk factor for mortality after transcatheter aortic valve replacement for severe aortic stenosis, but the impact of different types of AF on clinical outcomes remains unclear. Methods: This retrospective study included 982 patients divided into 3...
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The Texas Heart Institute
2024-12-01
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| Series: | Texas Heart Institute Journal |
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| Online Access: | https://thij.kglmeridian.com/downloadpdf/view/journals/thij/51/2/article-e248402.pdf |
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| author | Yoshiyuki Yamashita, MD, PhD Serge Sicouri, MD Massimo Baudo, MD Roberto Rodriguez, MD Eric M. Gnall, DO Paul M. Coady, MD Harish Jarrett, MD Sandra V. Abramson, MD Katie M. Hawthorne, MD Scott M. Goldman, MD William A. Gray, MD Basel Ramlawi, MD |
| author_facet | Yoshiyuki Yamashita, MD, PhD Serge Sicouri, MD Massimo Baudo, MD Roberto Rodriguez, MD Eric M. Gnall, DO Paul M. Coady, MD Harish Jarrett, MD Sandra V. Abramson, MD Katie M. Hawthorne, MD Scott M. Goldman, MD William A. Gray, MD Basel Ramlawi, MD |
| author_sort | Yoshiyuki Yamashita, MD, PhD |
| collection | DOAJ |
| description | Background:
Atrial fibrillation (AF) is a recognized risk factor for mortality after transcatheter aortic valve replacement for severe aortic stenosis, but the impact of different types of AF on clinical outcomes remains unclear.
Methods:
This retrospective study included 982 patients divided into 3 groups: no AF, paroxysmal AF, and nonparoxysmal AF (persistent or permanent). Clinical outcomes were analyzed using inverse probability weighting and multivariate models.
Results:
There were 610, 211, and 161 patients in the no-AF, paroxysmal AF, and nonparoxysmal AF groups, respectively. For the entire cohort, the mean (SD) age was 82 (7.7) years, and the periprocedural, 1-year, and 5-year mortality rates were 2.0%, 12%, and 50%, respectively. After inverse probability weighting, the periprocedural mortality rate was higher in the nonparoxysmal AF group than in the no-AF group (odds ratio, 4.71 [95% CI, 1.24-17.9]). During 5 years of follow-up (median [IQR], 22 [0-69] months), all-cause mortality was higher in the nonparoxysmal AF group than in the no-AF group (hazard ratio [HR], 1.56 [95% CI, 1.14-2.14]; P = .006). The paroxysmal AF group was not associated with worse clinical outcomes than the no-AF group (HR, 1.02 [95% CI, 0.81-1.49]) for all-cause mortality. Stroke rates were comparable among the 3 groups. Multivariate analysis also showed increased all-cause mortality in the nonparoxysmal AF group compared with the no-AF group (adjusted HR, 1.43 [95% CI, 1.06-1.93]; P = .018), while all-cause mortality was comparable between the paroxysmal AF and no-AF groups (adjusted HR, 1.00 [95% CI, 0.75-1.33]).
Conclusion:
In patients undergoing transcatheter aortic valve replacement for severe aortic stenosis, having nonparoxysmal AF was associated with a higher risk of periprocedural and all-cause mortality compared with having no AF. Paroxysmal AF showed no such association. |
| format | Article |
| id | doaj-art-c33fb0ebf720411087f94104ed911480 |
| institution | OA Journals |
| issn | 1526-6702 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | The Texas Heart Institute |
| record_format | Article |
| series | Texas Heart Institute Journal |
| spelling | doaj-art-c33fb0ebf720411087f94104ed9114802025-08-20T02:38:17ZengThe Texas Heart InstituteTexas Heart Institute Journal1526-67022024-12-0151211110.14503/THIJ-24-8402i1526-6702-51-2-e248402Impact of Atrial Fibrillation Type on Outcomes of Transcatheter Aortic Valve Replacement for Aortic Stenosis: A Single-Center AnalysisYoshiyuki Yamashita, MD, PhD0Serge Sicouri, MD1Massimo Baudo, MD2Roberto Rodriguez, MD3Eric M. Gnall, DO4Paul M. Coady, MD5Harish Jarrett, MD6Sandra V. Abramson, MD7Katie M. Hawthorne, MD8Scott M. Goldman, MD9William A. Gray, MD10Basel Ramlawi, MD111 Department of Cardiothoracic Surgery Research, Lankenau Institute for Medical Research, Wynnewood, Pennsylvania1 Department of Cardiothoracic Surgery Research, Lankenau Institute for Medical Research, Wynnewood, Pennsylvania1 Department of Cardiothoracic Surgery Research, Lankenau Institute for Medical Research, Wynnewood, Pennsylvania2 Department of Cardiothoracic Surgery, Lankenau Heart Institute, Main Line Health, Wynnewood, Pennsylvania3 Department of Interventional Cardiology, Lankenau Heart Institute, Main Line Health, Wynnewood, Pennsylvania3 Department of Interventional Cardiology, Lankenau Heart Institute, Main Line Health, Wynnewood, Pennsylvania4 Department of Cardiovascular Disease, Lankenau Heart Institute, Main Line Health, Wynnewood, Pennsylvania4 Department of Cardiovascular Disease, Lankenau Heart Institute, Main Line Health, Wynnewood, Pennsylvania4 Department of Cardiovascular Disease, Lankenau Heart Institute, Main Line Health, Wynnewood, Pennsylvania2 Department of Cardiothoracic Surgery, Lankenau Heart Institute, Main Line Health, Wynnewood, Pennsylvania3 Department of Interventional Cardiology, Lankenau Heart Institute, Main Line Health, Wynnewood, Pennsylvania1 Department of Cardiothoracic Surgery Research, Lankenau Institute for Medical Research, Wynnewood, PennsylvaniaBackground: Atrial fibrillation (AF) is a recognized risk factor for mortality after transcatheter aortic valve replacement for severe aortic stenosis, but the impact of different types of AF on clinical outcomes remains unclear. Methods: This retrospective study included 982 patients divided into 3 groups: no AF, paroxysmal AF, and nonparoxysmal AF (persistent or permanent). Clinical outcomes were analyzed using inverse probability weighting and multivariate models. Results: There were 610, 211, and 161 patients in the no-AF, paroxysmal AF, and nonparoxysmal AF groups, respectively. For the entire cohort, the mean (SD) age was 82 (7.7) years, and the periprocedural, 1-year, and 5-year mortality rates were 2.0%, 12%, and 50%, respectively. After inverse probability weighting, the periprocedural mortality rate was higher in the nonparoxysmal AF group than in the no-AF group (odds ratio, 4.71 [95% CI, 1.24-17.9]). During 5 years of follow-up (median [IQR], 22 [0-69] months), all-cause mortality was higher in the nonparoxysmal AF group than in the no-AF group (hazard ratio [HR], 1.56 [95% CI, 1.14-2.14]; P = .006). The paroxysmal AF group was not associated with worse clinical outcomes than the no-AF group (HR, 1.02 [95% CI, 0.81-1.49]) for all-cause mortality. Stroke rates were comparable among the 3 groups. Multivariate analysis also showed increased all-cause mortality in the nonparoxysmal AF group compared with the no-AF group (adjusted HR, 1.43 [95% CI, 1.06-1.93]; P = .018), while all-cause mortality was comparable between the paroxysmal AF and no-AF groups (adjusted HR, 1.00 [95% CI, 0.75-1.33]). Conclusion: In patients undergoing transcatheter aortic valve replacement for severe aortic stenosis, having nonparoxysmal AF was associated with a higher risk of periprocedural and all-cause mortality compared with having no AF. Paroxysmal AF showed no such association.https://thij.kglmeridian.com/downloadpdf/view/journals/thij/51/2/article-e248402.pdftranscatheter aortic valve replacementatrial fibrillationaortic valve |
| spellingShingle | Yoshiyuki Yamashita, MD, PhD Serge Sicouri, MD Massimo Baudo, MD Roberto Rodriguez, MD Eric M. Gnall, DO Paul M. Coady, MD Harish Jarrett, MD Sandra V. Abramson, MD Katie M. Hawthorne, MD Scott M. Goldman, MD William A. Gray, MD Basel Ramlawi, MD Impact of Atrial Fibrillation Type on Outcomes of Transcatheter Aortic Valve Replacement for Aortic Stenosis: A Single-Center Analysis Texas Heart Institute Journal transcatheter aortic valve replacement atrial fibrillation aortic valve |
| title | Impact of Atrial Fibrillation Type on Outcomes of Transcatheter Aortic Valve Replacement for Aortic Stenosis: A Single-Center Analysis |
| title_full | Impact of Atrial Fibrillation Type on Outcomes of Transcatheter Aortic Valve Replacement for Aortic Stenosis: A Single-Center Analysis |
| title_fullStr | Impact of Atrial Fibrillation Type on Outcomes of Transcatheter Aortic Valve Replacement for Aortic Stenosis: A Single-Center Analysis |
| title_full_unstemmed | Impact of Atrial Fibrillation Type on Outcomes of Transcatheter Aortic Valve Replacement for Aortic Stenosis: A Single-Center Analysis |
| title_short | Impact of Atrial Fibrillation Type on Outcomes of Transcatheter Aortic Valve Replacement for Aortic Stenosis: A Single-Center Analysis |
| title_sort | impact of atrial fibrillation type on outcomes of transcatheter aortic valve replacement for aortic stenosis a single center analysis |
| topic | transcatheter aortic valve replacement atrial fibrillation aortic valve |
| url | https://thij.kglmeridian.com/downloadpdf/view/journals/thij/51/2/article-e248402.pdf |
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