New-onset atrial fibrillation detected by ambulatory ECG monitoring after transcatheter aortic valve implantation

Jorge Nuche; Fady Soliman; Jorge Chavarría; Alexis K Okoh; Hugo Alvarado Mora; Isabelle Nault; Madhu K Natarajan; Mark Russo; François Philippon; Josep Rodés-Cabau

doi:10.4244/EIJ-D-23-01014

New-onset atrial fibrillation detected by ambulatory ECG monitoring after transcatheter aortic valve implantation

EuroIntervention. 2024 May 10;20(9):591-601. doi: 10.4244/EIJ-D-23-01014.

Authors

Affiliations

¹ Quebec Heart and Lung Institute, Laval University, Quebec City, QC, Canada.
² Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
³ McMaster University, Hamilton, ON, Canada and Hamilton Health Sciences, Hamilton, ON, Canada.
⁴ Division of Cardiology, Emory University, Atlanta, GA, USA.
⁵ Clínic Barcelona, Barcelona, Spain.

PMID: 38726722
PMCID: PMC11067725 (available on 2025-05-10)
DOI: 10.4244/EIJ-D-23-01014

Abstract

Background: Little is known about the occurrence of subclinical new-onset atrial fibrillation (NOAF) after transcatheter aortic valve implantation (TAVI).

Aims: We aimed to evaluate the incidence, predictors, and clinical impact of subclinical NOAF after TAVI.

Methods: This was a multicentre study, including patients with aortic stenosis (AS) and no previous atrial fibrillation undergoing TAVI, with continuous ambulatory electrocardiogram (AECG) monitoring after TAVI.

Results: A total of 700 patients (79±8 years, 49% female, Society of Thoracic Surgeons score 2.9% [1.9-4.0]) undergoing transarterial TAVI were included (85% balloon-expandable valves). AECG was started 1 (0-1) day after TAVI (monitoring time: 14121314 days). NOAF was detected in 49 patients (7%), with a median duration of 185 (43-421) minutes (atrial fibrillation burden of 0.7% [0.3-2.8]). Anticoagulation was started in 25 NOAF patients (51%). No differences were found in baseline or procedural characteristics, except for a higher AS severity in the NOAF group (peak gradient: no NOAF: 71.9±23.5 mmHg vs NOAF: 85.2±23.8 mmHg; p=0.024; mean gradient: no NOAF: 44.4±14.7 mmHg vs NOAF: 53.8±16.8 mmHg; p=0.004). In the multivariable analysis, the baseline mean transaortic gradient was associated with a higher risk of NOAF after TAVI (odds ratio 1.04, 95% confidence interval: 1.01-1.06 for each mmHg; p=0.006). There were no differences between groups in all-cause mortality (no NOAF: 4.7% vs NOAF: 0%; p=0.122), stroke (no NOAF: 1.4% vs NOAF: 2.0%; p=0.723), or bleeding (no NOAF: 1.9% vs NOAF: 4.1%; p=0.288) from the 30-day to 1-year follow-up.

Conclusions: NOAF detected with AECG occurred in 7% of TAVI recipients and was associated with a higher AS severity. NOAF detection determined the start of anticoagulation therapy in about half of the patients, and it was not associated with an increased risk of clinical events at 1-year follow-up.

Publication types

Multicenter Study

MeSH terms

Aged
Aged, 80 and over
Aortic Valve Stenosis* / surgery
Atrial Fibrillation* / diagnosis
Atrial Fibrillation* / physiopathology
Electrocardiography, Ambulatory* / methods
Female
Humans
Male
Risk Factors
Transcatheter Aortic Valve Replacement* / adverse effects
Treatment Outcome