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

• Published in: Journal of the American College of Cardiology 2014-04, Vol.63 (15), p.1510-1519
• Main Authors: 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
• Format: Article
• Language: English
• Subjects: Aged, 80 and over; Aorta, Thoracic; Aortic Valve Stenosis - diagnostic imaging; Aortic Valve Stenosis - surgery; Atrial Fibrillation - epidemiology; Atrial Fibrillation - etiology; Biological and medical sciences; Cardiac Catheterization - adverse effects; Cardiac Catheterization - methods; Cardiac dysrhythmias; Cardiology. Vascular system; Confidence Intervals; Echocardiography; Female; Femoral Artery; Follow-Up Studies; Heart; Heart Valve Prosthesis Implantation - adverse effects; Heart Valve Prosthesis Implantation - methods; Humans; Incidence; Male; Medical sciences; Odds Ratio; Postoperative Complications; Retrospective Studies; Risk Factors; Time Factors; Treatment Outcome; United States - epidemiology
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/j.jacc.2013.11.046

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.