Details

Autor(en) / Beteiligte

• TANAWUTTIWAT, Tanyanan
• O'NEILL, Brian P
• WILLIAMS, Donald B
• O'NEILL, William W
• MYERBURG, Robert J
• COHEN, Mauricio G
• CHINTHAKANAN, Orawee
• HELDMAN, Alan W
• MARTINEZ, Claudia A
• ALFONSO, Carlos E
• MITRANI, Raul D
• MACON, Conrad J
• CARRILLO, Roger G

Titel

New-Onset Atrial Fibrillation After Aortic Valve Replacement: Comparison of Transfemoral, Transapical, Transaortic, and Surgical Approaches

Ist Teil von

• Journal of the American College of Cardiology, 2014-04, Vol.63 (15), p.1510-1519

Ort / Verlag

New York, NY: Elsevier

Erscheinungsjahr

2014

Quelle

Access via ScienceDirect (Elsevier)

Beschreibungen/Notizen

• This study sought to determine the incidence of new-onset atrial fibrillation (AF) associated with different methods of isolated aortic valve replacement (AVR)-transfemoral (TF), transapical (TA), and transaortic (TAo) catheter-based valve replacement and conventional surgical approaches. The relative incidences of AF associated with the various access routes for AVR have not been well characterized. In this single-center, retrospective cohort study, we evaluated a total of 231 consecutive patients who underwent AVR for degenerative aortic stenosis (AS) between March 2010 and September 2012. Patients with a history of paroxysmal, persistent, or chronic AF, with bicuspid aortic valves, and patients who died within 48 h after AVR were excluded. A total of 123 patients (53% of total group) qualified for inclusion. Data on documented episodes of new-onset AF, along with all clinical, echocardiographic, procedural, and 30-day follow-up data, were collated. AF occurred in 52 patients (42.3%). AF incidence varied according to the procedural method. AF occurred in 60% of patients who underwent surgical AVR (SAVR), in 53% after TA-TAVR, in 33% after TAo-TAVR cases, and 14% after TF-TAVR. The episodes occurred at a median time interval of 53 (25th to 75th percentile, 41 to 87) h after completion of the procedure. Procedures without pericardiotomy had an 82% risk reduction of AF compared with those with pericardiotomy (adjusted odds ratio: 0.18; 95% confidence interval: 0.05 to 0.59). AF was a common complication of AVR with a cumulative incidence of >40% in elderly patients with degenerative AS who underwent either SAVR or TAVR. AF was most common with SAVR and least common with TF-TAVR. Procedures without pericardiotomy were associated with a lower incidence of AF.