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IMPACT OF PREOPERATIVE ATRIAL FIBRILLATION ON ONE YEAR MORTALITY AND QUALITY OF LIFE FOLLOWING TRANSCATHETER AORTIC VALVE REPLACEMENT
Abstract   Open access   Peer reviewed

IMPACT OF PREOPERATIVE ATRIAL FIBRILLATION ON ONE YEAR MORTALITY AND QUALITY OF LIFE FOLLOWING TRANSCATHETER AORTIC VALVE REPLACEMENT

Raymond G. McKay, Sean Robert McMahon, Nicole E. Hoover, Lauren Curtis, William L. Duvall, Bhaskar Arora, Jeff Mather, Hina Amin and Ritika Kompella
Journal of the American College of Cardiology, Vol.79(9 Suppl), pp.753-753
03/08/2022
DOI: 10.1016/S0735-1097(22)01744-2
url
https://doi.org/10.1016/S0735-1097(22)01744-2View
Published (Version of record) Open Access

Abstract

Background: Although prior studies have shown that new onset atrial fibrillation (AFIB) is common after transcatheter aortic valve replacement (TAVR) and is associated with higher risk of long-term stroke and mortality, the impact of pre-operative AFIB on TAVR outcomes remains uncertain. Methods: From a total cohort of 2,058 TAVR patients, we compared clinical outcomes in 786 patients with pre-operative paroxysmal (n=390) or permanent (n=396) AFIB with 1,272 non-AFIB patients. Relative improvements in Quality of Life (QOL) were measured in 800 patients with completed baseline and 1-year Kansas City Cardiomyopathy Questionnaire (KCCQ-12) surveys. Logistic regression was used to identify a poor TAVR outcome in all patients, defined as mortality, a KCCQ-12 score < 60 or a decrease in KCCQ-12 score >10 post TAVR at 1-year follow-up. Results: In comparison to the non-AFIB cohort, AFIB patients were older (83.0 ± 7.5 vs 80.3 ± 9.0 yrs, p<0.001), more likely male (58% vs 53%, p=0.017), and had more comorbidities including hypertension (91% vs 89%, p=0.04), chronic lung disease (55% vs 44%, p<001), prior stroke (14% vs 9%, p<0.001) and prior transient ischemic attacks (8% vs 9%, p=0.009). AFIB patients had a higher baseline STS-PROM (11.71 ± 7.80 vs 8.81 ± 7.09, p<0.001) and a lower pre-procedure KCCQ-12 score (42.4 ± 24.6 vs 50.7 ± 25.6, p<001). There were no differences between AFIB and non-AFIB patients with respect to major in-hospital outcomes including death, stroke, need for permanent pacemaker and vascular complications, although the AFIB cohort had a longer length of stay post TAVR (4.1 ± 4.8 vs 3.5 ± 3.8 days, p=0.014). Logistic regression revealed that pre-operative AFIB was an independent predictor of a poor 1-year TAVR outcome for both paroxysmal (HR 2.25, 95% CI 1.25-4.25, p=0.007) and permanent (HR 4.26, 95% CI 2.49-7.89, p<001) subgroups. Conclusion: Both pre-operative paroxysmal and persistent AFIB are independent predictors of mortality and poor quality of life one year following TAVR.

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