Yamashita Yoshiyuki, Sicouri Serge, Baudo Massimo, Rodriguez Roberto, Gnall Eric M, Coady Paul M, Jarrett Harish, Abramson Sandra V, Hawthorne Katie M, Goldman Scott M, Gray William A, Ramlawi Basel
Department of Cardiothoracic Surgery Research, Lankenau Institute for Medical Research, Wynnewood, Pennsylvania.
Department of Cardiothoracic Surgery, Lankenau Heart Institute, Main Line Health, Wynnewood, Pennsylvania.
Tex Heart Inst J. 2024 Dec 12;51(2):e248402. doi: 10.14503/THIJ-24-8402. eCollection 2024 Jul-Dec.
Atrial fibrillation (AF) is a recognized risk factor for mortality after transcatheter aortic valve replacement for severe aortic stenosis, but the impact of different types of AF on clinical outcomes remains unclear.
This retrospective study included 982 patients divided into 3 groups: no AF, paroxysmal AF, and nonparoxysmal AF (persistent or permanent). Clinical outcomes were analyzed using inverse probability weighting and multivariate models.
There were 610, 211, and 161 patients in the no-AF, paroxysmal AF, and nonparoxysmal AF groups, respectively. For the entire cohort, the mean (SD) age was 82 (7.7) years, and the periprocedural, 1-year, and 5-year mortality rates were 2.0%, 12%, and 50%, respectively. After inverse probability weighting, the periprocedural mortality rate was higher in the nonparoxysmal AF group than in the no-AF group (odds ratio, 4.71 [95% CI, 1.24-17.9]). During 5 years of follow-up (median [IQR], 22 [0-69] months), all-cause mortality was higher in the nonparoxysmal AF group than in the no-AF group (hazard ratio [HR], 1.56 [95% CI, 1.14-2.14]; = .006). The paroxysmal AF group was not associated with worse clinical outcomes than the no-AF group (HR, 1.02 [95% CI, 0.81-1.49]) for all-cause mortality. Stroke rates were comparable among the 3 groups. Multivariate analysis also showed increased all-cause mortality in the nonparoxysmal AF group compared with the no-AF group (adjusted HR, 1.43 [95% CI, 1.06-1.93]; = .018), while all-cause mortality was comparable between the paroxysmal AF and no-AF groups (adjusted HR, 1.00 [95% CI, 0.75-1.33]).
In patients undergoing transcatheter aortic valve replacement for severe aortic stenosis, having nonparoxysmal AF was associated with a higher risk of periprocedural and all-cause mortality compared with having no AF. Paroxysmal AF showed no such association.
心房颤动（AF）是严重主动脉瓣狭窄经导管主动脉瓣置换术后死亡率的一个公认危险因素，但不同类型的房颤对临床结局的影响仍不明确。
这项回顾性研究纳入了982例患者，分为3组：无房颤、阵发性房颤和非阵发性房颤（持续性或永久性）。使用逆概率加权法和多变量模型分析临床结局。
无房颤组、阵发性房颤组和非阵发性房颤组分别有610例、211例和161例患者。对于整个队列，平均（标准差）年龄为82（7.7）岁，围手术期、1年和5年死亡率分别为2.0%、12%和50%。经过逆概率加权后，非阵发性房颤组的围手术期死亡率高于无房颤组（比值比，4.71[95%CI，1.24 - 17.9]）。在5年的随访期间（中位数[四分位间距]，22[0 - 69]个月），非阵发性房颤组的全因死亡率高于无房颤组（风险比[HR]，1.56[95%CI，1.14 - 2.14]；P = 0.006）。阵发性房颤组与无房颤组相比，全因死亡率的临床结局并无更差（HR，1.02[95%CI，0.81 - 1.49]）。三组的卒中发生率相当。多变量分析还显示，与无房颤组相比，非阵发性房颤组的全因死亡率增加（校正HR，1.43[95%CI，1.06 - 1.93]；P = 0.018），而阵发性房颤组和无房颤组之间的全因死亡率相当（校正HR，1.00[95%CI，0.75 - 1.33]）。
在因严重主动脉瓣狭窄接受经导管主动脉瓣置换术的患者中，与无房颤相比，患有非阵发性房颤与围手术期和全因死亡风险更高相关。阵发性房颤则无此关联。
