Baseline Characteristics and Prognostic Implications of Pre-Existing and New-Onset Atrial Fibrillation After Transcatheter Aortic Valve Implantation Results From the FRANCE-2 Registry
Baseline Characteristics and Prognostic Implications of Pre-Existing and New-Onset Atrial Fibrillation After Transcatheter Aortic Valve Implantation Results From the FRANCE-2 Registry
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DOI：
10.1016/j.jcin.2015.06.010
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发表时间：
2015-08-24
影响因子：
11.3
通讯作者：
Schiele, Francois
中科院分区：
文献类型：
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作者：
Chopard, Romain;Teiger, Emmanuel;Schiele, Francois
本研究的目的是确定既存房颤（AF）患者和经导管主动脉瓣植入术（TAVI）后新发AF患者的基线特征和临床结局。背景关于TAVI后AF的影响知之甚少。方法FRANCE-2注册研究包括所有接受TAVI的患者（N = 3，933），2010年和2011年在法国。新发房颤定义为术后发生房颤的患者无记录的AF病史。结果25.8%的患者在TAVI前记录了AF。在无既存AF病史的患者中，174例TAVI后观察到新发AF（6.0%）。1年时，全因死亡率（分别为26.5%和16.6%; p < 0.001）（分别为11.5%和7.8%; P < 0.001）在术前与无AF的患者相比，存在AF的患者中，因心力衰竭恶化和纽约心脏协会功能分级而再次住院的患者也较高与无房颤的患者相比，有房颤的患者的合并疗效终点率更高（p < 0.001）。中风史，外科手术史（非经股动脉）方法，心脏病学，和出血性手术相关事件均与术后新发AF的发生独立相关。在无既存AF的患者中，新发AF与30天时合并安全性终点的发生率较高相关（p < 0.001），1年时全因死亡率和联合疗效终点率均较高（分别为p = 0.003和p = 0.02）。结论：既存和新发AF均与TAVI后较高的死亡率和发病率相关。(C)2015年由美国心脏病学会基金会。
OBJECTIVES The aim of this study was to determine baseline characteristics and clinical outcomes of patients with pre-existing atrial fibrillation (AF) and of patients who presented with new-onset AF after transcatheter aortic valve implantation (TAVI).BACKGROUND Little is known regarding the impact of AF after TAVI.METHODS The FRANCE-2 registry included all patients undergoing TAVI (N = 3,933) in France in 2010 and 2011. New-onset AF was defined as the occurrence of AF post-procedure in a patient with no documented history of AF.RESULTS AF was documented before TAVI in 25.8% of patients. New-onset AF was observed in 174 patients after TAVI among patients without a history of pre-existing AF (6.0%). At 1 year, the rates of all-cause death (26.5 vs. 16.6%, respectively; p < 0.001) and cardiovascular death (11.5 vs. 7.8%, respectively; p < 0.001) were significantly higher in patients with pre-existing AF compared with those without AF. Rehospitalization for worsening heart failure and New York Heart Association functional class was also higher in patients with pre-existing AF versus those without, resulting in a higher rate of combined efficacy endpoint in this group (p < 0.001). A history of stroke, surgical (nontransfemoral) approach, cardiological, and hemorrhagic procedure-related events were all independently related to the occurrence of new-onset post-procedural AF. New-onset AF in patients without pre-existing AF was associated with a higher rate of combined safety endpoint at 30 days (p < 0.001) and a higher rate of both all-cause death and combined efficacy endpoint at 1 year (p = 0.003 and p = 0.02, respectively).CONCLUSIONS Pre-existing and new-onset AF are both associated with higher mortality and morbidity after TAVI. (C) 2015 by the American College of Cardiology Foundation.