Mengi Siddhartha, Cepas-Guillén Pedro, Ternacle Julien, Urena Marina, Alperi Alberto, Cheema Asim N, Veiga-Fernandez Gabriela, Nombela-Franco Luis, Vilalta Victoria, Esposito Giovanni, Campelo-Parada Francisco, Indolfi Ciro, Del Trigo Maria, Muñoz-Garcia Antonio, Maneiro Nicolas, Asmarats Lluís, Regueiro Ander, Del Val David, Serra Vicenç, Auffret Vincent, Leroux Lionel, Modine Thomas, Mesnier Jules, Suc Gaspard, Avanzas Pablo, Rezaei Effat, Fradejas-Sastre Victor, Tirado-Conte Gabriela, Fernández-Nofrerias Eduard, Angellotti Domenico, Guitteny Thibaut, Sorrentino Sabato, Oteo Juan Francisco, Díez-Delhoyo Felipe, Gutiérrez-Alonso Lola, Vidal-Calés Pablo, Alfonso Fernando, Monastyrski Andrea, Nolf Maxime, Avvedimento Marisa, Rodés-Cabau Josep
Quebec Heart & Lung Institute, Laval University, Québec City, Québec, Canada.
Unité Médico-Chirurgicale des Valvulopathies, Hôpital Haut-Leveque, CHU Bordeaux, Pessac, France.
Can J Cardiol. 2025 May;41(5):860-870. doi: 10.1016/j.cjca.2024.12.007. Epub 2024 Dec 10.
Atrial fibrillation (AF) has been identified as a marker of advanced cardiac damage in patients with aortic stenosis. However, the factors associated with poorer outcomes among AF patients in contemporary transcatheter aortic valve replacement (TAVR) practice, particularly regarding mortality and heart failure (HF)-related hospitalizations, remain largely unknown.
In this multicenter study, we assessed consecutive patients with a history of AF and evaluated the clinical outcomes of those who underwent TAVR with newer generation devices using either balloon- or self-expandable valves.
A total of 3476 patients were included in the study. After a median follow-up of 2 (interquartile range, 1-4) years, 36.1% patients had died, with 51.5% of deaths being cardiovascular-related, including 15.6% from HF. HF-related hospitalizations post-TAVR accounted for 34.8% of all hospitalizations and were associated with a higher mortality risk (hazard ratio [HR], 1.54; 95% confidence interval [CI], 1.32-1.81; P < 0.001). Permanent AF was identified as an independent predictor of all-cause mortality or HF-related hospitalizations (HR, 1.25; 95% CI, 1.10-1.40; P < 0.001), as did other baseline characteristics, including chronic kidney disease (HR, 1.23; 95% CI, 1.09-1.38; P = 0.001), anemia (HR, 1.21; 95% CI, 1.07-1.36; P = 0.002), and New York Heart Association functional class III or IV (HR, 1.13; 95% CI, 1.01-1.27; P = 0.045). In addition, early postprocedural complications, including stroke and bleeding, also significantly increased the risk of mortality (HR, 5.52; 95% CI, 3.12-9.79; P < 0.001) and HF-related hospitalizations (HR, 1.17; 95% CI, 1.03-1.33; P = 0.014).
AF patients exhibited a high risk of mortality and HF-related hospitalizations in a contemporary TAVR cohort. Several baseline comorbidities and periprocedural complications, along with permanent (vs paroxysmal) AF, were associated with poorer outcomes. These findings confirm the negative impact of AF despite the continued improvements in TAVR technology and underscore the importance of early intervention and optimization of HF management to improve outcomes in this high-risk population.
心房颤动（AF）已被确定为主动脉瓣狭窄患者心脏严重损害的一个标志。然而，在当代经导管主动脉瓣置换术（TAVR）实践中，与AF患者预后较差相关的因素，尤其是关于死亡率和心力衰竭（HF）相关住院方面，仍大多未知。
在这项多中心研究中，我们评估了有AF病史的连续患者，并评估了使用新一代球囊扩张式或自膨胀式瓣膜进行TAVR治疗的患者的临床结局。
该研究共纳入3476例患者。中位随访2（四分位间距，1 - 4）年后，36.1%的患者死亡，其中51.5%的死亡与心血管相关，包括15.6%死于HF。TAVR术后HF相关住院占所有住院的34.8%，且与更高的死亡风险相关（风险比[HR]，1.54；95%置信区间[CI]，1.32 - 1.81；P < 0.001）。永久性AF被确定为全因死亡率或HF相关住院的独立预测因素（HR，1.25；95% CI，1.10 - 1.40；P < 0.001），其他基线特征包括慢性肾脏病（HR，1.23；95% CI，1.09 - 1.38；P = 0.001）、贫血（HR，1.21；95% CI，1.07 - 1.36；P = 0.002）以及纽约心脏协会功能分级III或IV级（HR，1.13；95% CI，1.01 - 1.27；P = 0.045）也是如此。此外，术后早期并发症，包括卒中与出血，也显著增加了死亡风险（HR，5.52；95% CI，3.12 - 9.79；P < 0.001）和HF相关住院风险（HR，1.1
