| Institution: | 1. Cardiovascular Research Foundation, New York, New York, USA;2. Division of Cardiac Surgery, Northwestern University, Chicago, Illinois, USA;3. NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA;4. Marcus Heart Valve Center, Piedmont Heart Institute, Atlanta, Georgia, USA;5. Division of Cardiac Surgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA;6. Baylor Scott & White Health, Plano, Texas, USA;7. Emory University Medical Center, Atlanta, Georgia, USA;8. Cleveland Clinic, Cleveland, Ohio, USA;9. Quebec Heart and Lung Institute, Laval University, Quebec, Quebec, Canada;10. University of Washington, Seattle, Washington, USA;11. NYU Langone Medical Center, New York, New York, USA;12. Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, New Jersey, USA;13. Edwards Lifesciences, Irvine, California, USA;14. St. Paul’s Hospital, Vancouver, British Columbia, Canada |
| Abstract: | ObjectivesThe aim of this study was to assess the incidence and prognostic impact of early and late postoperative atrial fibrillation or flutter (POAF) in patients with severe aortic stenosis (AS) treated with transcatheter aortic valve replacement (TAVR) or surgical aortic valve replacement (SAVR).BackgroundThere is an ongoing controversy regarding the incidence, recurrence rate, and prognostic impact of early (in-hospital) POAF and late (postdischarge) POAF in patients with AS undergoing TAVR or SAVR.MethodsIn the PARTNER (Placement of Aortic Transcatheter Valve) 3 trial, patients with severe AS at low surgical risk were randomized to TAVR or SAVR. Analyses were performed in the as-treated population excluding patients with preexistent atrial fibrillation or flutter.ResultsAmong 781 patients included in the analysis, early POAF occurred in 152 (19.5%) (18 of 415 4.3%] and 134 of 366 36.6%] following TAVR and SAVR, respectively). Following discharge, 58 new or recurrent late POAF events occurred within 1 year following the index procedure in 55 of 781 patients (7.0%). Early POAF was not an independent predictor of late POAF following discharge (odds ratio: 1.04; 95% CI: 0.52-2.08; P = 0.90). Following adjustment, early POAF was not an independent predictor of the composite outcome of death, stroke, or rehospitalization (hazard ratio: 1.10; 95% CI: 0.64-1.92; P = 0.72), whereas late POAF was associated with an increased adjusted risk for the composite outcome (hazard ratio: 8.90; 95% CI: 5.02-15.74; P < 0.0001), irrespective of treatment modality.ConclusionsIn the PARTNER 3 trial, early POAF was more frequent following SAVR compared with TAVR. Late POAF, but not early POAF, was significantly associated with worse outcomes at 2 years, irrespective of treatment modality. |
