Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada.
JACC Cardiovasc Interv. 2022 Mar 28;15(6):603-613. doi: 10.1016/j.jcin.2022.01.018.
The authors aimed to identify risk factors and outcomes associated with new-onset atrial fibrillation (NOAF) after transcatheter aortic valve replacement (TAVR).
NOAF is a common complication after TAVR, although estimates of the precise occurrence are variable. This study sought to quantify the occurrence of NOAF after TAVR and to explore the outcomes and predictors associated with this complication.
We searched Medline, EMBASE, and the Cochrane database from 2016 to 2020 for articles that reported NOAF after TAVR. We extracted data for studies published before 2016 from a previous systematic review. We pooled data using a random effects model.
We identified 179 studies with 241,712 total participants (55,271 participants with pre-existing atrial fibrillation (AF) were excluded) that reported NOAF from 2008 to 2020. The pooled occurrence of NOAF after TAVR was 9.9% (95% CI: 8.1%-12%). NOAF after TAVR was associated with a longer index hospitalization (mean difference = 2.66 days; 95% CI: 1.05-4.27), a higher risk of stroke in the first 30 days (risk ratio [RR]: 2.35; 95% CI: 2.12-2.61), 30-day mortality (RR: 1.76; 95% CI: 1.12-2.76), major or life-threatening bleeding (RR: 1.60; 95% CI: 1.39-1.84), and permanent pacemaker implantation (RR: 1.12; 95% CI: 1.05-1.18). Risk factors for the development of NOAF after TAVR included higher Society of Thoracic Surgeons score, transapical access, pulmonary hypertension, chronic kidney disease, peripheral vascular disease, and severe mitral regurgitation, suggesting that the risk for NOAF is highest in more comorbid TAVR patients.
NOAF is common after TAVR. Whether AF after TAVR is a causal factor or a marker of sicker patients remains unclear.
作者旨在确定经导管主动脉瓣置换术（TAVR）后新发心房颤动（NOAF）的相关风险因素和结局。
NOAF 是 TAVR 后的常见并发症，尽管确切发生率存在差异。本研究旨在量化 TAVR 后 NOAF 的发生情况，并探讨与该并发症相关的结局和预测因素。
我们检索了 2016 年至 2020 年的 Medline、EMBASE 和 Cochrane 数据库，以获取报道 TAVR 后新发心房颤动的文章。我们从先前的系统评价中提取了 2016 年之前发表的研究数据。我们使用随机效应模型对数据进行了汇总。
我们共确定了 179 项研究，其中有 241712 名患者（排除了 55271 名患有预发性心房颤动的患者）报告了 2008 年至 2020 年 TAVR 后的新发心房颤动。TAVR 后新发心房颤动的发生率为 9.9%（95%CI：8.1%-12%）。TAVR 后新发心房颤动与住院时间延长相关（平均差异=2.66 天；95%CI：1.05-4.27），30 天内发生中风的风险更高（风险比[RR]：2.35；95%CI：2.12-2.61），30 天死亡率（RR：1.76；95%CI：1.12-2.76），主要或危及生命的出血（RR：1.60；95%CI：1.39-1.84），以及永久性起搏器植入（RR：1.12；95%CI：1.05-1.18）。TAVR 后新发心房颤动的风险因素包括较高的胸外科医师协会评分、经心尖入路、肺动脉高压、慢性肾脏病、外周血管疾病和严重二尖瓣反流，表明在合并症更多的 TAVR 患者中，NOAF 的风险最高。
NOAF 在 TAVR 后很常见。TAVR 后发生的心房颤动是否为因果因素或更严重患者的标志物尚不清楚。
