Kim Jitae A, Najam Usman S, Ternes Caique M P, Marashly Qussay, Chelu Mihail G
Division of Cardiovascular Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, 875 Ellicott Street Suite 7030, Buffalo, NY, 14203, USA.
Department of Internal Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA.
Cardiovasc Drugs Ther. 2024 Jun 13. doi: 10.1007/s10557-024-07577-x.
New onset atrial fibrillation (NOAF) is a common occurrence after transcatheter aortic valve replacement (TAVR) and portends a poorer prognosis. The optimal strategy for managing NOAF in this population is uncertain.
This retrospective cohort study utilized deidentified patient data from the TriNetX Research Network. Patients with TAVR and NOAF were stratified into a rhythm control cohort if they were treated with antiarrhythmics, received AF ablation, or underwent cardioversion within 1 year of AF diagnosis. A rate control cohort was similarly defined by the absence of rhythm control strategies and treatment with a beta blocker, calcium channel blocker, or digoxin. After 1:1 propensity score matching, the Kaplan-Meier survival analysis and Cox proportional hazard ratios (HRs) were used to compare outcomes at 7 years of follow-up.
We identified 569 patients in each cohort following propensity matching. At 7 years, the primary composite outcome of all-cause death, myocardial infarction, cerebrovascular accident, and heart failure hospitalization was not significantly different between the rhythm and rate control cohorts (HR 0.99, 95% CI 0.83-1.18). The individual components of the primary outcome in addition to all-cause hospitalization were also similar between the groups.
Similar outcomes were seen among patients receiving an early rhythm or rate control strategy to manage NOAF after TAVR. The attenuated benefits of an early rhythm control strategy observed in this setting may be due to the overall high burden of comorbidities and advanced age of these patients.
新发房颤（NOAF）是经导管主动脉瓣置换术（TAVR）后常见的情况，预示着预后较差。在这一人群中管理NOAF的最佳策略尚不确定。
这项回顾性队列研究利用了TriNetX研究网络中去识别化的患者数据。TAVR和NOAF患者如果在房颤诊断后1年内接受抗心律失常药物治疗、接受房颤消融或进行心脏复律，则被分层到节律控制队列。类似地，心率控制队列由未采用节律控制策略且使用β受体阻滞剂、钙通道阻滞剂或地高辛治疗来定义。在1:1倾向评分匹配后，使用Kaplan-Meier生存分析和Cox比例风险比（HRs）来比较7年随访期的结果。
倾向匹配后，我们在每个队列中识别出569例患者。在7年时，节律控制队列和心率控制队列在全因死亡、心肌梗死、脑血管意外和心力衰竭住院的主要复合结局方面没有显著差异（HR 0.99，95%CI 0.83-1.18）。除全因住院外，主要结局的各个组成部分在两组之间也相似。
在TAVR后采用早期节律或心率控制策略管理NOAF的患者中观察到了相似的结果。在这种情况下观察到的早期节律控制策略的益处减弱可能是由于这些患者共病负担总体较高且年龄较大。
