Prognostic value of new onset atrial fibrillation after transcatheter aortic valve implantation: A FRANCE 2 registry substudy

Akira Furuta (1, 2) , Nicolas Lellouche (3, 1, 2) , Gauthier Mouillet (1, 2) , Tarvinder Dhanjal (1, 2) , Martine Gilard (4) , Marc Laskar (5, 6) , Hélène Eltchaninoff (7) , Jean Fajadet (8) , Bernard Lung (9) , Patrick Donzeau-Gouge (10) , Pascal Leprince (11) , Alain Leguerrier (12) , Alain Prat (13) , Jean-Luc Dubois-Randé (2, 14) , Emmanuel Teiger (15, 14, 2)

1 Hôpital Henri Mondor
2 Service de cardiologie
3 IMRB - Institut Mondor de recherche biomédicale
4 ORPHY (EA 4324) - Optimisation des régulations physiologiques
5 Service de Chirurgie Thoracique et Vasculaire - Médecine vasculaire [CHU Limoges]
6 ERMA - Equipe de Recherche Médicale Appliquée
7 Service de Cardiologie [CHU Rouen]
8 Clinique Pasteur [Toulouse]
9 Service de cardiologie
10 ICPS - Institut Cardiovasculaire Paris Sud
11 CHU Pitié-Salpêtrière [AP-HP]
12 Service de chirurgie thoracique cardiaque et vasculaire [Rennes] = Thoracic and Cardiovascular Surgery [Rennes]
13 CHRU Lille - Centre Hospitalier Régional Universitaire [CHU Lille]
14 IMRB - Institut Mondor de Recherche Biomédicale
15 CHU Henri Mondor - Département de physiologie

Background The development of new onset atrial fibrillation (NOAF) post-transcatheter aortic valve implantation (TAVI) is common and may be associated with an adverse prognosis. This study seeks to identify incidence, predictors, and impact of NOAF post-TAVI. Methods From the multicenter study of the French national transcatheter aortic valve implantation registry, FRANCE 2, a total of 1959 patients with sinus rhythm prior to TAVI were enrolled into this study. The incidence of post-TAVI NOAF, predictors of development of NOAF and impact on 30-day and 1-year-mortalities were assessed. Results Of the 1959 TAVI patients (mean-age: 82.6 ± 7.5 years, mean-logistic-EuroSCORE: 21.8 ± 14.3), 149 (7.6%) developed NOAF with the remaining 1810 (92.4%) control patients demonstrating no evidence of AF as defined by the Valve Academic Research Consortium (VARC). Advanced age and major and life-threatening bleeding were independent predictors of NOAF (95% CI: 0.93–0.99; p = 0.006, 95% CI: 1.58–4.00; p < 0.001, 95% CI: 1.09–3.75; p = 0.025, respectively). A trend towards a higher incidence of major and life-threatening bleeding was observed in the patients undergoing TAVI via the transapical (TA)-approach compared with the transfemoral (TF)-approach. Both 30-day and cumulative 1-year-mortalities were significantly higher in patients with NOAF compared to patients without NOAF (3.0% vs. 7.4%; p = 0.005, 9.1% vs. 20.8%; p < 0.001, respectively). In addition, NOAF was an independent predictor of 30-day and 1-year-mortalities (HR: 2.16; 95% CI: 1.06–4.41; p = 0.033, HR: 2.12; 95% CI: 1.42–3.15; p < 0.001, respectively). Conclusion Advanced age and major and life-threatening bleeding were independently associated with increased incidence of NOAF, which itself was an independent predictor of 30-day and 1-year-mortalities. With regards to the various transcatheter approaches, a trend towards a higher incidence of major and life-threatening bleeding was observed only with the TA-approach.

Mots clés: aortic stenosis; atrial fibrillation; TAVI

Domaines: Chirurgie; Cardiologie et système cardiovasculaire

Akira Furuta, Nicolas Lellouche, Gauthier Mouillet, Tarvinder Dhanjal, Martine Gilard, et al.. Prognostic value of new onset atrial fibrillation after transcatheter aortic valve implantation: A FRANCE 2 registry substudy. International Journal of Cardiology, 2016, 210, pp.72-79. ⟨10.1016/j.ijcard.2016.02.073⟩. ⟨hal-01274300⟩