Advertisement

Temporal changes of new-onset atrial fibrillation in patients randomized to surgical or transcatheter aortic valve replacement

  • Author Footnotes
    1 All authors takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Troels Højsgaard Jørgensen
    Correspondence
    Corresponding author at: The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Section 2012, Blegdamsvej 9, 2100 Copenhagen, Denmark.
    Footnotes
    1 All authors takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Affiliations
    Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, 2100 Copenhagen, Denmark
    Search for articles by this author
  • Author Footnotes
    1 All authors takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Hans Gustav Hørsted Thyregod
    Footnotes
    1 All authors takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Affiliations
    Department of Cardiothoracic Surgery, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, 2100 Copenhagen, Denmark
    Search for articles by this author
  • Author Footnotes
    1 All authors takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Julie Bjerre Tarp
    Footnotes
    1 All authors takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Affiliations
    Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, 2100 Copenhagen, Denmark
    Search for articles by this author
  • Author Footnotes
    1 All authors takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Jesper Hastrup Svendsen
    Footnotes
    1 All authors takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Affiliations
    Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, 2100 Copenhagen, Denmark

    Department of Clinical Medicine, University of Copenhagen, 2100 Copenhagen, Denmark

    Danish Arrhythmia Research Centre, University of Copenhagen, 2100 Copenhagen, Denmark
    Search for articles by this author
  • Author Footnotes
    1 All authors takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Lars Søndergaard
    Footnotes
    1 All authors takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Affiliations
    Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, 2100 Copenhagen, Denmark

    Department of Clinical Medicine, University of Copenhagen, 2100 Copenhagen, Denmark
    Search for articles by this author
  • Author Footnotes
    1 All authors takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
Published:February 23, 2017DOI:https://doi.org/10.1016/j.ijcard.2017.02.098

      Abstract

      Background

      Temporal development of new-onset atrial fibrillation (NOAF) after aortic valve replacement is unclear, and opportunistic screening has limited diagnostic accuracy. This is the first study to investigate the incidence and temporal development of NOAF detected by implantable loop recorder (ILR) in patients with aortic stenosis, randomized to surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR).

      Method

      An ILR was implanted in a subgroup of patients without pre-procedural atrial fibrillation (AF), randomized to SAVR or TAVR in the NOTION trial. Data from the ILR were transmitted in intervals of 2 weeks for 12 weeks post-procedurally and analyzed.

      Results

      The study included 25 and 27 patients who underwent SAVR and TAVR, respectively. The cumulative rate of NOAF was 100% and 81.5% for patients undergoing SAVR and TAVR, respectively (P = 0.06). TAVR patients without NOAF 6 weeks post-procedurally remained free from NOAF. The prevalence of AF after SAVR decreased significantly after 8 weeks when compared with the first 2 weeks (50.0% vs. 84.0%, respectively; P < 0.05). The prevalence of AF after TAVR did not change significantly during follow-up. The median AF burden (percentage of time with AF) was 2.8% and 0.04% during the first 2 weeks after SAVR and TAVR, respectively (P = 0.01) and it decreased significantly over time after SAVR but not after TAVR.

      Conclusion

      NOAF subsided 6 weeks after TAVR. AF prevalence and burden decreased significantly over time after SAVR, but remained stable after TAVR. These findings may be considered for post-procedural anti-coagulation strategy.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to International Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Nkomo V.T.
        • Gardin J.M.
        • Skelton T.N.
        • Gottdiener J.S.
        • Scott C.G.
        • Enriquez-Sarano M.
        Burden of valvular heart diseases: a population-based study.
        Lancet. 2006; 368: 1005-1011
        • Faggiano P.
        • Aurigemma G.P.
        • Rusconi C.
        • Gaasch W.H.
        Progression of valvular aortic stenosis in adults: literature review and clinical implications.
        Am. Heart J. 1996; 132: 408-417
        • Kodali S.K.
        • Williams M.R.
        • Smith C.R.
        • et al.
        Two-year outcomes after transcatheter or surgical aortic-valve replacement.
        N. Engl. J. Med. 2012; 366: 1686-1695
        • Makkar R.R.
        • Fontana G.P.
        • Jilaihawi H.
        • et al.
        Transcatheter aortic-valve replacement for inoperable severe aortic stenosis.
        N. Engl. J. Med. 2012; 366: 1696-1704
        • Varadarajan P.
        • Kapoor N.
        • Bansal R.C.
        • Pai R.G.
        Survival in elderly patients with severe aortic stenosis is dramatically improved by aortic valve replacement: results from a cohort of 277 patients aged > or = 80 years.
        Eur. J. Cardiothorac. Surg. 2006; 30: 722-727
        • Amat-Santos I.J.
        • Rodes-Cabau J.
        • Urena M.
        • et al.
        Incidence, predictive factors, and prognostic value of new-onset atrial fibrillation following transcatheter aortic valve implantation.
        J. Am. Coll. Cardiol. 2012; 59: 178-188
        • Filardo G.
        • Hamilton C.
        • Hamman B.
        • Hebeler R.F.
        • Adams J.
        • Grayburn P.
        New-onset postoperative atrial fibrillation and long-term survival after aortic valve replacement surgery.
        Ann. Thorac. Surg. 2010; 90: 474-479
        • Ruel M.
        • Masters R.G.
        • Rubens F.D.
        • et al.
        Late incidence and determinants of stroke after aortic and mitral valve replacement.
        Ann. Thorac. Surg. 2004; 78: 77-83
        • Stortecky S.
        • Buellesfeld L.
        • Wenaweser P.
        • et al.
        Atrial fibrillation and aortic stenosis: impact on clinical outcomes among patients undergoing transcatheter aortic valve implantation.
        Circ. Cardiovasc. Interv. 2013; 6: 77-84
        • Motloch L.J.
        • Reda S.
        • Rottlaender D.
        • et al.
        Postprocedural atrial fibrillation after transcatheter aortic valve implantation versus surgical aortic valve replacement.
        Ann. Thorac. Surg. 2012; 93: 124-131
        • Thyregod H.G.
        • Steinbruchel D.A.
        • Ihlemann N.
        • et al.
        Transcatheter versus surgical aortic valve replacement in patients with severe aortic valve stenosis: 1-year results from the all-comers NOTION randomized clinical trial.
        J. Am. Coll. Cardiol. 2015; 65: 2184-2194
        • Hindricks G.
        • Pokushalov E.
        • Urban L.
        • et al.
        Performance of a new leadless implantable cardiac monitor in detecting and quantifying atrial fibrillation: results of the XPECT trial.
        Circ. Arrhythm. Electrophysiol. 2010; 3: 141-147
        • Appel C.F.
        • Hultkvist H.
        • Nylander E.
        • et al.
        Transcatheter versus surgical treatment for aortic stenosis: patient selection and early outcome.
        Scand. Cardiovasc. J. 2012; 46: 301-307
        • Jorgensen T.H.
        • Thygesen J.B.
        • Thyregod H.G.
        • Svendsen J.H.
        • Sondergaard L.
        New-onset atrial fibrillation after surgical aortic valve replacement and transcatheter aortic valve implantation: a concise review.
        J. Invasive Cardiol. 2015; 27: 41-47
        • Charitos E.I.
        • Stierle U.
        • Ziegler P.D.
        • et al.
        A comprehensive evaluation of rhythm monitoring strategies for the detection of atrial fibrillation recurrence: insights from 647 continuously monitored patients and implications for monitoring after therapeutic interventions.
        Circulation. 2012; 126: 806-814
        • Engelmann M.D.
        • Svendsen J.H.
        Inflammation in the genesis and perpetuation of atrial fibrillation.
        Eur. Heart J. 2005; 26: 2083-2092
        • Jong G.P.
        • Chen H.Y.
        • Li S.Y.
        • Liou Y.S.
        Long-term effect of antihypertensive drugs on the risk of new-onset atrial fibrillation: a longitudinal cohort study.
        Hypertens. Res. 2014; 37: 950-953
        • Boriani G.
        • Glotzer T.V.
        • Santini M.
        • et al.
        Device-detected atrial fibrillation and risk for stroke: an analysis of >10,000 patients from the SOS AF project (stroke prevention strategies based on atrial fibrillation information from implanted devices).
        Eur. Heart J. 2014; 35: 508-516
        • Tay E.L.
        • Gurvitch R.
        • Wijesinghe N.
        • et al.
        A high-risk period for cerebrovascular events exists after transcatheter aortic valve implantation.
        JACC Cardiovasc. Interv. 2011; 4: 1290-1297
        • Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC)
        • European Association for Cardio-Thoracic Surgery (EACTS)
        • Vahanian A.
        • Alfieri O.
        • Andreotti F.
        • et al.
        Guidelines on the management of valvular heart disease (version 2012).
        Eur. Heart J. 2012; 33: 2451-2496
        • Merie C.
        • Kober L.
        • Skov Olsen P.
        • et al.
        Association of warfarin therapy duration after bioprosthetic aortic valve replacement with risk of mortality, thromboembolic complications, and bleeding.
        JAMA. 2012; 308: 2118-2125