经导管主动脉瓣植入术患者中房颤的预后影响
Prognostic impact of atrial fibrillation in patients undergoing transcatheter aortic valve implantation.
作者信息
Reichl Jakob J, Stolte Thorald, Boeddinghaus Jasper, Wagener Max, Leibundgut Gregor, Badertscher Patrick, Sticherling Christian, Kühne Michael, Kaiser Christoph, Mahfoud Felix, Nestelberger Thomas
机构信息
Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland.
出版信息
Heart Rhythm O2. 2025 Jan 10;6(3):273-279. doi: 10.1016/j.hroo.2024.12.016. eCollection 2025 Mar.
BACKGROUND
Atrial fibrillation (AF) is the most common arrhythmia and an important risk factor for adverse cardiac outcomes, including heart failure and stroke. Moreover, AF has been linked to worse outcomes after transcatheter aortic valve implantation (TAVI). Real-world data on the impact of AF on outcomes after TAVI remain limited.
OBJECTIVE
To assess the impact of AF on periprocedural and short-term outcomes after TAVI.
METHODS
Patients undergoing TAVI at a tertiary center were consecutively included in a prospective registry. Cardiac rhythm at baseline was assessed using 12-lead ECGs. The primary outcome was all-cause mortality at 30 days. Secondary outcomes included all-cause mortality at 1 year, stroke at 30 days and 1 year, and procedural success, defined as freedom from periprocedural mortality, surgical re-interventions, re-interventions of the aortic valve, major access site complications, and periprocedural bleedings until discharge.
RESULTS
Among 1655 patients undergoing TAVI, 428 patients (25.6%) had preexisting AF, and 77 patients (4.6%) were diagnosed with new-onset AF during hospitalization for TAVI. AF was not associated with higher mortality at 30 days (3.7% vs 2.0%; = .054, adjusted hazard ratio [aHR], 1.8 [95% confidence interval (CI), 0.9-3.4]), but at 1 year (13.8% vs 8.4%; = .001; aHR, 1.6 [95%CI, 1.2-2.2]). The stroke rate was higher in patients with AF at 30 days (5.9% vs 2.7%; = .003; aHR, 2.1 [95%CI, 1.2-3.5]) and at 1 year (7.1% vs 3.8%; = .005; aHR, 1.8 [95%CI, 1.2-2.9]). At discharge, 452 patients (89.5%) with AF received oral anticoagulation. After adjusting for anticoagulant therapy, the difference in stroke risk at 30 days (5.7% vs 2.3%; = .058) and 1 year (6.8% vs 4.2%; = .165) was no longer significant. Patients with AF experienced more major or life-threatening bleeding complications (14.2% vs 10.6%; = .043). There were no differences in procedural success between patients with and those without AF (78.8% vs 78.3%; = .886).
CONCLUSION
AF was associated with increased mortality at 1 year and higher rates of stroke and major bleeding at 30 days and 1 year after TAVI.
背景
心房颤动（AF）是最常见的心律失常，也是包括心力衰竭和中风在内的不良心脏结局的重要危险因素。此外，AF与经导管主动脉瓣植入术（TAVI）后更差的结局相关。关于AF对TAVI后结局影响的真实世界数据仍然有限。
目的
评估AF对TAVI围手术期和短期结局的影响。
方法
在一家三级中心接受TAVI的患者连续纳入前瞻性登记研究。使用12导联心电图评估基线时的心律。主要结局是30天全因死亡率。次要结局包括1年全因死亡率、30天和1年中风发生率，以及手术成功率，手术成功定义为无围手术期死亡、外科再次干预、主动脉瓣再次干预、主要穿刺部位并发症和围手术期出血直至出院。
结果
在1655例接受TAVI的患者中，428例（25.6%）既往有AF，77例（4.6%）在TAVI住院期间被诊断为新发AF。AF与30天更高的死亡率无关（3.7%对2.0%；P = 0.054，调整后风险比[aHR]，1.8[95%置信区间（CI），0.9 - 3.4]），但与1年死亡率相关（13.8%对8.4%；P = 0.001；aHR，1.6[95%CI，1.2 - 2.2]）。AF患者30天时的中风发生率更高（5.9%对2.7%；P = 0.003；aHR，2.1[95%CI，1.2 - 3.5]），1年时也是如此（7.1%对3.8%；P = 0.005；aHR，1.8[95%CI，1.2 - 2.9]）。出院时，452例（89.5%）AF患者接受了口服抗凝治疗。在调整抗凝治疗后，30天（5.7%对2.3%；P = 0.058）和1年（6.8%对4.2%；P = 0.165）中风风险的差异不再显著。AF患者经历了更多严重或危及生命的出血并发症（14.2%对10.6%；P = 0.043）。有AF和无AF患者的手术成功率无差异（78.8%对78.3%；P = 0.886）。
结论
AF与TAVI后1年死亡率增加以及30天和1年时更高的中风和严重出血发生率相关。
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