A meta-analysis of the impact of pre-existing and new-onset atrial fibrillation on clinical outcomes in patients undergoing transcatheter aortic valve implantation

Item Type:	Article
Title:	A meta-analysis of the impact of pre-existing and new-onset atrial fibrillation on clinical outcomes in patients undergoing transcatheter aortic valve implantation
Creators Name:	Sannino, A. and Gargiulo, G. and Schiattarella, G.G. and Perrino, C. and Stabile, E. and Losi, M.A. and Galderisi, M. and Izzo, R. and de Simone, G. and Trimarco, B. and Esposito, G.
Abstract:	AIMS: Little is known about the prognostic role of pre-existing atrial fibrillation (AF) and new-onset AF (NOAF) in transcatheter aortic valve implantation (TAVI). Therefore, the aim of this meta-analysis was to compare the short- and long-term clinical outcomes of patients undergoing TAVI with and without pre-existing and new-onset AF. METHODS AND RESULTS: Twenty-six studies, enrolling 14,078 patients undergoing TAVI, of whom 33.4% had pre-existing AF and 17.5% had NOAF, were analysed for early and long-term all-cause mortality, cardiovascular mortality and cerebrovascular events (CVE). In patients with pre-existing AF, 30-day all-cause mortality was similar to patients in sinus rhythm (SR). Conversely, long-term all-cause and cardiovascular mortality were significantly greater in pre-existing AF patients than in patients with SR (20 studies; 8,743 patients; HR: 1.68; p<0.00001, and three studies; 1,138 patients; HR: 2.07; p=0.01, respectively). Pre-existing AF was not a predictor of CVE at long-term follow-up. NOAF patients showed similar short- and long-term all-cause mortality when compared to patients in SR, whereas they experienced a significantly higher incidence of CVE at short-term follow-up (six studies; 2,025 patients; HR: 2.86; p<0.00001). A non-significant increase in the incidence of CVE was observed at long-term follow-up. CONCLUSIONS: Pre-existing AF is a predictor of all-cause mortality in patients undergoing TAVI. NOAF is related to the occurrence of CVE at short-term follow-up. Similarly to surgical aortic valve replacement (SAVR), the optimal management and risk stratification of these patients should be further investigated.
Keywords:	Mortality, New-Onset Atrial Fibrillation, Pre-Existing Atrial Fibrillation, Severe Aortic Stenosis, Transcatheter Aortic Valve Implantation
Source:	EuroIntervention
ISSN:	1774-024X
Publisher:	Europa Group
Volume:	12
Number:	8
Page Range:	e1047-e1056
Date:	10 October 2016
Official Publication:	https://doi.org/10.4244/EIJY15M11_12
PubMed:	View item in PubMed

Repository Staff Only: item control page