Impact of Atrial Fibrillation on Patients Undergoing Transcatheter Aortic Valve Implantation (TAVI): The K-TAVI Registry
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Purpose: The incidence and prognostic implications of atrial fibrillation (AF) in patients with severe aortic stenosis (AS) undergo ing transcatheter aortic valve implantation (TAVI) are controversial, especially for Korean patients. Furthermore, the pattern of an tithrombotic therapy for these patients is unknown. The present study sought to identify the impact of AF on Korean patients un dergoing TAVI and demonstrate the status of antithrombotic therapy for these patients. Materials and Methods: A total of 660 patients who underwent TAVI for severe AS were recruited from the nationwide K-TAVI registry in Korea. The enrolled patients were stratified into sinus rhythm (SR) and AF groups. The primary endpoint was all-cause death at 1-year. Results: AF was recorded in 135 patients [pre-existing AF 108 (16.4%) and new-onset AF 27 (4.1%)]. The rate of all-cause death at 1 year was significantly higher in patients with AF than in those with SR [16.2% vs. 6.4%, adjusted hazard ratio (HR): 2.207, 95% con fidence interval (CI): 1.182–4.120, p=0.013], regardless of the onset timing of AF. The rate of new pacemaker insertion at 1 year was also significantly higher in patients with AF than in those with SR (14.0% vs. 5.5%, adjusted HR: 3.137, 95%CI: 1.621–6.071, p=0.001). Among AF patients, substantial number of patients received the combination of multiple antithrombotic agents (77.8%), and the most common combination was that of aspirin and clopidogrel (38.1%). Conclusion: AF was an independent predictor of 1-year mortality and new pacemaker insertion in Korean patients undergoing TAVI.
Abstract
Purpose: The incidence and prognostic implications of atrial fibrillation (AF) in patients with severe aortic stenosis (AS) undergo ing transcatheter aortic valve implantation (TAVI) are controversial, especially for Korean patients. Furthermore, the pattern of an tithrombotic therapy for these patients is unknown. The present study sought to identify the impact of AF on Korean patients un dergoing TAVI and demonstrate the status of antithrombotic therapy for these patients. Materials and Methods: A total of 660 patients who underwent TAVI for severe AS were recruited from the nationwide K-TAVI registry in Korea. The enrolled patients were stratified into sinus rhythm (SR) and AF groups. The primary endpoint was all-cause death at 1-year. Results: AF was recorded in 135 patients [pre-existing AF 108 (16.4%) and new-onset AF 27 (4.1%)]. The rate of all-cause death at 1 year was significantly higher in patients with AF than in those with SR [16.2% vs. 6.4%, adjusted hazard ratio (HR): 2.207, 95% con fidence interval (CI): 1.182–4.120, p=0.013], regardless of the onset timing of AF. The rate of new pacemaker insertion at 1 year was also significantly higher in patients with AF than in those with SR (14.0% vs. 5.5%, adjusted HR: 3.137, 95%CI: 1.621–6.071, p=0.001). Among AF patients, substantial number of patients received the combination of multiple antithrombotic agents (77.8%), and the most common combination was that of aspirin and clopidogrel (38.1%). Conclusion: AF was an independent predictor of 1-year mortality and new pacemaker insertion in Korean patients undergoing TAVI.
참고문헌 (25)
- Vahanian A, "2021 ESC", EACTS guidelines for the management of valvular heart disease, 2021, pp.60, 727~800
- Writing Committee Members, "2020 ACC", AHA guideline for the management of patients with valvular heart disease : a report of the American College of Cardiology, J Am Coll Cardiol, pp.2021, 77[DOI]
- Mentias A, "Impact of pre-existing and new-onset atrial fibrillation on outcomes after transcatheter aortic valve replacement", JACC Cardiovasc Interv, 12, pp.2119~2129 (2019)
- Sannino A, "A meta-analysis of the impact of pre-existing and newonset atrial fibrillation on clinical outcomes in patients undergoing transcatheter aortic valve implantation", EuroIntervention, 12, pp.e1047~e1056 (2016)
- Filardo G, "New-onset postoperative atrial fibrillation and long-term survival after aortic valve replacement surgery", Ann Thorac Surg, 90, pp.474~479 (2010)
- Jørgensen TH, "New-onset atrial fibrillation after surgical aortic valve replacement and transcatheter aortic valve implantation : a concise review", J Invasive Cardiol, 27, pp.41~47 (2015)
- Tarantini G, "Atrial fibrillation in patients undergoing transcatheter aortic valve implantation : epidemiology, timing, predictors, and outcome", Eur Heart J, 38, pp.1285~1293 (2017)
- Amat-Santos IJ, "Incidence, predictive factors, and prognostic value of new-onset atrial fibrillation following transcatheter aortic valve implantation", J Am Coll Cardiol, 59, pp.178~188 (2012)
- Chopard R, "Baseline characteristics and prognostic implications of pre-existing and new-onset atrial fibrillation after transcatheter aortic valve implantation : results from the FRANCE-2 registry", JACC Cardiovasc Interv, 8, pp.1346~1355 (2015)
- Tarantini G, "Prevalence and impact of atrial fibrillation in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement : an analysis from the SOURCE XT prospective multicenter registry", JACC Cardiovasc Interv, 9, pp.937~946 (2016)
- Stortecky S, "Atrial fibrillation and aortic stenosis : impact on clinical outcomes among patients undergoing transcatheter aortic valve implantation", Circ Cardiovasc Interv, 6, pp.77~84 (2013)
- Shahim B, "Postoperative atrial fibrillation or flutter following transcatheter or surgical aortic valve replacement : PARTNER 3 trial", JACC Cardiovasc Interv, 14, pp.1565~1574 (2021)
- Mojoli M, "Impact of atrial fibrillation on outcomes of patients treated by transcatheter aortic valve implantation : a systematic review and meta-analysis", Am Heart J, 192, pp.64~75 (2017)
- Nishimura RA, "2017 AHA", ACC focused update of the 2014AHA, American Heart Association Task Force on clinical practice guidelines, pp.J Am Coll Cardiol, 2017[DOI]
- Rossi JE, "Variability in antithrombotic therapy regimens peri-TAVR : a single academic center experience", Cardiol Ther, 4, pp.197~201 (2015)
- Camm AJ, "Guidelines for the management of atrial fibrillation : the task force for the management of atrial fibrillation of the European Society of Cardiology(ESC)", Eur Heart J, 31, pp.2369~2429 (2010)
- Kappetein AP, "Updated standardized endpoint definitions for transcatheter aortic valve implantation : the valve academic research consortium-2 consensus document", J Am Coll Cardiol, 60, pp.1438~1454 (2012)
- Rodriguez CJ, "Atrial fibrillation incidence and risk factors in relation to race-ethnicity and the population attributable fraction of atrial fibrillation risk factors : the multi-ethnic study of atherosclerosis", Ann Epidemiol, 25, pp.71~76 (2015)
- Chopard R, "Baseline characteristics and prognostic implications of pre-existing and new-onset atrial fibrillation after transcatheter aortic valve implantation : results from the FRANCE-2 registry", JACC Cardiovasc Interv, 8, pp.1346~1355 (2015)
- Biviano AB, "Atrial fibrillation is associated with increased mortality in patients undergoing transcatheter aortic valve replacement : insights from the placement of aortic transcatheter valve(PARTNER)trial", Circ Cardiovasc Interv, 9, pp.e002766~ (2016)
- Siontis GC, "Predictors of permanent pacemaker implantation in patients with severe aortic stenosis undergoing TAVR : a meta-analysis", J Am Coll Cardiol, 64, pp.129~140 (2014)
- Fadahunsi OO, "Incidence, predictors, and outcomes of permanent pacemaker implantation following transcatheter aortic valve replacement : analysis from the U. S. Society of Thoracic Surgeons", American College of Cardiology TVT registry, 2016, pp.9, 2189~2199
- Kapadia S, "Insights into timing, risk factors, and outcomes of stroke and transient ischemic attack after transcatheter aortic valve replacement in the PARTNER trial(placement of aortic transcatheter valves)", Circ Cardiovasc Interv, 9, pp.e002981~ (2016)
- Nombela-Franco L, "Timing, predictive factors, and prognostic value of cerebrovascular events in a large cohort of patients undergoing transcatheter aortic valve implantation", Circulation, 126, pp.3041~3053 (2012)
- Sherwood MW, "Variation in antithrombotic therapy and clinical outcomes in patients with preexisting atrial fibrillation undergoing transcatheter aortic valve replacement : insights from the Society of Thoracic Surgeons", American College of Cardiology Transcatheter Valve Therapy Registry, 2021, pp.14, e009963~