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Clinical and prognostic implications of atrial fibrillation in patients undergoing transcatheter aortic valve implantation

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Author(s): Pablo Salinas | Raúl Moreno | Luis Calvo | Santiago Jiménez-Valero | Guillermo Galeote | Angel Sánchez-Recalde | Teresa López-Fernández | Sergio Garcia-Blas | Diego Iglesias | Luis Riera | Isidro Moreno-Gómez | Jose María Mesa | Ignacio Plaza | Rocio Ayala | Rosa Gonzalez | José-Luis López-Sendón

Journal: World Journal of Cardiology
ISSN 1949-8462

Volume: 4;
Issue: 1;
Start page: 8;
Date: 2012;
Original page

Keywords: Aortic stenosis | Transcatheter aortic valve implantation | Stroke | Atrial fibrillation

ABSTRACT
AIM: To study a cohort of consecutive patients undergoing transcatheter aortic valve implantation (TAVI) and compare the outcomes of atrial fibrillation (AF) patients vs patients in sinus rhythm (SR). METHODS: All consecutive patients undergoing TAVI in our hospital were included. The AF group comprised patients in AF at the time of TAVI or with history of AF, and were compared with the SR group. Procedural, echocardiographic and follow-up variables were compared. Likewise, the CHA2DS2-VASC stroke risk score and HAS-BLED bleeding risk score and antithrombotic treatment at discharge in AF patients were compared with that in SR patients. RESULTS: From a total of 34 patients undergoing TAVI, 17 (50%) were allocated to the AF group, of whom 15 (88%) were under chronic oral anticoagulation. Patients in the AF group were similar to those in the SR group except for a trend (P = 0.07) for a higher logistic EuroSCORE (28% vs 19%), and a higher prevalence of hypertension (82% vs 53%) and chronic renal failure (17% vs 0%). Risk of both stroke and bleeding was high in the AF group (mean CHA2DS2-VASC 4.3, mean HAS-BLED 2.9). In the AF group, treatment at discharge included chronic oral anticoagulation in all except one case, and in association with an antiplatelet drug in 57% of patients. During a mean follow-up of 11 mo (maximum 32), there were only two strokes, none of them during the peri-procedural period: one in the AF group at 30 mo and one in the SR group at 3 mo. There were no statistical differences in procedural success, and clinical outcome (survival at 1 year 81% vs 74% in AF and SR groups, respectively, P = NS). CONCLUSION: Patients in AF undergoing TAVI show a trend to a higher surgical risk. However, in our cohort, patients in AF did not have a higher stroke rate compared to the SR group, and the prognosis was similar in both groups.

Tango Jona
Tangokurs Rapperswil-Jona

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