Pre‐Existing and New‐Onset Atrial Fibrillation in Patients Undergoing Transcatheter Aortic Valve Implantation

BACKGROUND: Atrial fibrillation (AF) is a frequent comorbidity in patients with severe aortic valve stenosis undergoing transcatheter aortic valve implantation (TAVI). In addition, new-onset AF can occur after TAVI. However, data on how AF affects outcomes in patients undergoing TAVI remain conflicting. AIMS: To assess clinical outcomes in patients with severe aortic valve stenosis with AF who undergo TAVI in a large real-world global cohort. METHODS: The CENTER2-study includes 25,771 patients that underwent TAVI between 2007 and 2022. The database consists of patient-level pooled data from 10 clinical studies. Objectives were rates of new-onset AF ≤ 30 days, and differences in mortality and stroke according to AF status. RESULTS: A total of 23,320 patients were included in the current analysis (56.1% female; mean age 81.5 ± 6.7 years). Pre-existing AF was present in 28.2% (n = 6579) of patients. Mortality rates after TAVI were higher in patients with pre-existing AF (19.0% vs. 14.2%, adjusted HR: 1.39, 95% CI: 1.26-1.53, p < 0.001). Strokes at Day 3-30 after TAVI were more frequent in patients with pre-existing AF (1.6% vs. 1.1%, p = 0.004). New-onset AF occurred in 6.2% (n = 681) of patients without pre-existing AF. Mortality rates after TAVI were higher in patients with new-onset AF (adjusted HR 1.75, 95% CI 1.24-2.49, p = 0.002). One-year stroke was more frequently observed in patients with new-onset AF after exclusion of acute periprocedural stroke (6.1% vs. 3.4%, p = 0.04). Major bleeding was also more frequent in patients with new-onset AF (12.0% vs. 6.7%, p < 0.001). CONCLUSIONS: Patients with pre-existing or new-onset AF had higher mortality compared with patients without AF undergoing transfemoral TAVI. After the acute postprocedural period, 1-year stroke rates were higher in patients with new-onset AF. TRIAL REGISTRATION: ClinicalTrials.gov. Unique identifier NCT03588247.