Risk Factors and Prognostic Implications of New-Onset Atrial Fibrillation Following Transcatheter Aortic Valve Replacement

TL;DR

This study identifies risk factors for new-onset atrial fibrillation after heart valve replacement and finds it increases hospital readmissions but not mortality.

Contribution

The study identifies new-onset right bundle branch block and other factors as independent predictors of new-onset atrial fibrillation after TAVR.

Findings

New-onset RBBB, diabetes, hydropericardium, and severe tricuspid regurgitation are independent risk factors for NOAF after TAVR.

NOAF was associated with higher hospital readmissions at 3 and 5 years post-TAVR.

NOAF did not significantly increase mortality or stroke rates at 1, 3, or 5 years.

Abstract

Background: Transcatheter aortic valve replacement (TAVR) has become a standard treatment for severe aortic stenosis. New-onset atrial fibrillation (NOAF) is a common complication after TAVR, with significant implications for patient outcomes. This study aimed to identify the risk factors for NOAF and assess its impact on long-term prognosis following TAVR.

Methods: This retrospective single-center study included 601 patients who underwent TAVR between 2013 and 2021 at the Second Affiliated Hospital of Zhejiang University School of Medicine. Patients were categorized into two groups: those who maintained sinus rhythm before and after TAVR (SR/SR) and those who developed NOAF after TAVR (SR/AF). Univariate logistic regression analysis was first performed to identify potential risk factors for NOAF, with variables showing a p value < 0.1 included in the multivariate logistic regression model. Multivariate analysis was then conducted to identify independent risk factors for NOAF. The impact of NOAF on clinical outcomes, including all-cause mortality, cardiovascular death, hospital readmissions, stroke, and other major adverse cardiac events (MACE), was evaluated using logistic regression models adjusted for potential confounders such as age, sex, comorbidities, and procedural factors.

Results: Of the 601 patients, 56 (9.3%) developed NOAF. Univariate analysis identified hypercholesterolemia, diabetes mellitus, severe tricuspid regurgitation, hydropericardium, and new-onset right bundle branch block (RBBB) as potential risk factors for NOAF (p < 0.1). Multivariate analysis confirmed new-onset RBBB (OR 3.45, 95% CI 1.72–6.93, p < 0.001), diabetes mellitus (OR 2.36, 95% CI 1.25–4.47, p=0.008), hydropericardium (OR 2.74, 95% CI 1.38–5.45, p=0.004), and severe tricuspid regurgitation (OR 3.52, 95% CI 1.57–7.93, p=0.002) as independent risk factors for NOAF. Patients in the SR/AF group had significantly higher rates of heart failure, stroke, and mortality during follow-up compared to the SR/SR group. NOAF was also associated with increased hospital readmissions at 3 and 5 years post-TAVR (adjusted OR: 1.89, 95% CI: 1.12–3.18, p=0.017; and adjusted OR: 1.95, 95% CI: 1.15–3.31, p=0.013, respectively). However, there were no significant differences in all-cause mortality, cardiovascular death, stroke, or other MACE between the SR/AF and SR/SR groups at 1, 3, and 5 years.

Conclusions: NOAF is a common complication after TAVR and is associated with several independent risk factors, including new-onset RBBB, diabetes mellitus, hydropericardium, and severe tricuspid regurgitation. While NOAF did not significantly increase mortality in this cohort, it was associated with higher rates of hospital readmissions and recurrent cardiovascular events, highlighting the need for close monitoring and proactive management of NOAF in TAVR patients. These findings underscore the importance of identifying high-risk patients and implementing strategies to optimize post-procedural care and improve long-term outcomes.

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