Jeong Hyung Ki, Yoon Namsik, Kim Ju Han, Lee Nuri, Hyun Dae Yong, Kim Min Chul, Lee Ki Hong, Jeong Yo Cheon, Jeong In Seok, Yoon Hyun Ju, Kim Kye Hun, Park Hyung Wook, Ahn Youngkeun, Jeong Myung Ho, Cho Jeong Gwan
Division of Cardiology, Department of Internal Medicine, School of Medicine, Wonkwang University, Iksan, South Korea.
Division of Cardiology, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, South Korea.
Front Cardiovasc Med. 2021 Nov 29;8:789548. doi: 10.3389/fcvm.2021.789548. eCollection 2021.
Atrial fibrillation (AF) in severe aortic stenosis (AS) has poor outcomes after transcatheter and surgical aortic valve replacement (TAVR and SAVR, respectively). We compared the incidence of AF after aortic valve replacement (AVR) according to the treatment method and the impact of AF on outcomes. We investigated the incidence of AF and clinical outcomes of AVR according to whether AF occurred after TAVR and SAVR after propensity score (PS)-matching for 1 year follow-up. Clinical outcomes were defined as death, stroke, and admission due to heart failure. The composite outcome comprised death, stroke, and admission due to heart failure. A total of 221 patients with severe AS were enrolled consecutively, 100 of whom underwent TAVR and 121 underwent SAVR. The incidence of newly detected AF was significantly higher in the SAVR group before PS-matching (6.0 vs. 40.5%, < 0.001) and after PS-matching (7.5 vs. 35.6%, = 0.001). TAVR and SAVR showed no significant differences in outcomes except in terms of stroke. In the TAVR group, AF history did not affect the outcomes; however, in the SAVR group, AF history affected death (log rank = 0.038). Post-AVR AF had a worse impact on admission due to heart failure (log rank = 0.049) and composite outcomes in the SAVR group. Post-AVR AF had a worse impact on admission due to heart failure (log rank = 0.008) and composite outcome in the TAVR group. Post-AVR AF could be considered as a predictor of the outcomes of AVR. TAVR might be a favorable treatment option for patients with severe symptomatic AS who are at high-risk for AF development or who have a history of AF because the occurrence of AF was more frequent in the SAVR group.
严重主动脉瓣狭窄（AS）患者发生心房颤动（AF）后，经导管主动脉瓣置换术（TAVR）和外科主动脉瓣置换术（SAVR）的预后均较差。我们比较了根据治疗方法进行主动脉瓣置换术（AVR）后AF的发生率以及AF对预后的影响。我们根据倾向评分（PS）匹配后1年随访中TAVR和SAVR后是否发生AF，调查了AVR的AF发生率和临床结局。临床结局定义为死亡、中风和因心力衰竭入院。复合结局包括死亡、中风和因心力衰竭入院。共连续纳入221例严重AS患者，其中100例行TAVR，121例行SAVR。在PS匹配前，SAVR组新检测到AF的发生率显著高于TAVR组（6.0%对40.5%，P<0.001）；PS匹配后，差异仍显著（7.5%对35.6%，P = 0.001）。除中风外，TAVR和SAVR在结局方面无显著差异。在TAVR组，AF病史不影响结局；然而，在SAVR组，AF病史影响死亡（对数秩检验P = 0.038）。AVR后AF对SAVR组因心力衰竭入院（对数秩检验P = 0.049）和复合结局的影响更差。AVR后AF对TAVR组因心力衰竭入院（对数秩检验P = 0.008）和复合结局的影响也更差。AVR后AF可被视为AVR结局的预测指标。对于有AF发生高风险或有AF病史的严重症状性AS患者，TAVR可能是一种更好的治疗选择，因为SAVR组AF的发生率更高。
