Department of Cardiology, EA3920, University Hospital Besançon, Besançon, France.
Department of Cardiology, University Hospital Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris-Est Créteil, Créteil, France.
JACC Cardiovasc Interv. 2015 Aug 24;8(10):1346-1355. doi: 10.1016/j.jcin.2015.06.010.
The aim of this study was to determine baseline characteristics and clinical outcomes of patients with pre-existing atrial fibrillation (AF) and of patients who presented with new-onset AF after transcatheter aortic valve implantation (TAVI).
Little is known regarding the impact of AF after TAVI.
The FRANCE-2 registry included all patients undergoing TAVI (N = 3,933) in France in 2010 and 2011. New-onset AF was defined as the occurrence of AF post-procedure in a patient with no documented history of AF.
AF was documented before TAVI in 25.8% of patients. New-onset AF was observed in 174 patients after TAVI among patients without a history of pre-existing AF (6.0%). At 1 year, the rates of all-cause death (26.5 vs. 16.6%, respectively; p < 0.001) and cardiovascular death (11.5 vs. 7.8%, respectively; p < 0.001) were significantly higher in patients with pre-existing AF compared with those without AF. Rehospitalization for worsening heart failure and New York Heart Association functional class was also higher in patients with pre-existing AF versus those without, resulting in a higher rate of combined efficacy endpoint in this group (p < 0.001). A history of stroke, surgical (nontransfemoral) approach, cardiological, and hemorrhagic procedure-related events were all independently related to the occurrence of new-onset post-procedural AF. New-onset AF in patients without pre-existing AF was associated with a higher rate of combined safety endpoint at 30 days (p < 0.001) and a higher rate of both all-cause death and combined efficacy endpoint at 1 year (p = 0.003 and p = 0.02, respectively).
Pre-existing and new-onset AF are both associated with higher mortality and morbidity after TAVI.
本研究旨在确定经导管主动脉瓣置换术（TAVI）前存在心房颤动（AF）的患者和 TAVI 后新发 AF 患者的基线特征和临床结局。
对于 TAVI 后 AF 的影响知之甚少。
FRANCE-2 注册研究纳入了 2010 年和 2011 年法国所有接受 TAVI 的患者（n=3933）。新发 AF 定义为在无 AF 病史的患者中，术后出现 AF。
25.8%的患者在 TAVI 前记录到 AF。在无 AF 病史的患者中，174 例患者在 TAVI 后新发 AF（6.0%）。在 1 年时，与无 AF 患者相比，有 AF 病史的患者全因死亡率（分别为 26.5%和 16.6%；p<0.001）和心血管死亡率（分别为 11.5%和 7.8%；p<0.001）均显著更高。有 AF 病史的患者因心力衰竭恶化和纽约心脏协会心功能分级而再住院率也更高，因此该组的联合疗效终点发生率更高（p<0.001）。既往卒中史、非经股入路、心脏科和出血相关事件的发生均与新发术后 AF 的发生独立相关。无 AF 病史的患者新发 AF 与 30 天联合安全性终点发生率较高（p<0.001）和 1 年全因死亡率和联合疗效终点发生率较高相关（p=0.003 和 p=0.02，分别）。
TAVI 后存在和新发 AF 均与更高的死亡率和发病率相关。
