Article ID | Journal | Published Year | Pages | File Type |
---|---|---|---|---|
5594334 | American Heart Journal | 2017 | 12 Pages |
BackgroundConflicting data have been reported related to the impact of atrial fibrillation (AF) on the outcomes after transcatheter aortic valve implantation (TAVI). We aimed to assess the prognosis of TAVI-treated patients according to the presence of pre-existing or new-onset AF.MethodsStudies published between April 2002 and November 2016 and reporting outcomes of pre-existing AF, new-onset AF, or sinus rhythm in patients undergoing TAVI were identified with an electronic search. Pairwise and network meta-analysis were performed. Outcomes of interest were short- and long-term mortality, stroke, and major bleeding.ResultsEleven studies (11,033 individuals) were eligible. Compared to sinus rhythm, short-term and long-term mortality were significantly higher in new-onset AF (short-term OR 2.9, PÂ =Â .002; long-term OR 2.3, PÂ <Â .0001) and pre-existing AF groups (short-term OR 2.7, PÂ =Â .004; long-term OR 2.8, PÂ <Â .0001). Compared to sinus rhythm, new-onset AF increased the risk of stroke at early (OR 2.1, PÂ <Â .0001) and late follow-up (OR 1.92, PÂ <Â .0001), and the risk of early bleedings (OR 1.65, PÂ =Â .002), while pre-existing AF increased the risk of late stroke (OR 1.3, PÂ =Â 0.03), but not the risk of bleeding. Compared to pre-existing AF, new-onset AF correlated with higher risk of early stroke (OR 1.7, PÂ =Â .002) and major bleedings (OR 1.7, PÂ =Â .002).ConclusionsAF is associated with impaired outcomes after TAVI, including mortality, stroke and (limited to new-onset AF) major bleedings. Compared to pre-existing AF, new-onset AF correlates with higher risk of early stroke and major bleedings. Improved management of AF in the TAVI setting, including tailored antithrombotic treatment strategies, remains a relevant need.