Incidence of AFib after Aortic Valve Replacement

A recent study has found that atrial fibrillation (AFib) common occurrence following aortic valve replacement (AVR) and transcatheter aortic valve implantation (TAVI) may be a common occurrence, but is it also associated with an increase in incident length of stay, stroke, and in-hospital mortality.

The study, from researchers at the University of Alabama and the University of Minnesota, examined more than 170,000 aortic valve replacements from 2012 to 2015.

“The use of TAVI and aortic valve replacement will only continue to increase as the American population ages. However, we are now acknowledging that there can be many unintended effects from TAVI and surgical aortic valve replacement,” explained Rajat Kalra, MD, the study’s first author. “We felt strongly that we needed more data to clarify the effects of these procedures on heart rhythm, stroke and mortality for clinicians and patients who are jointly deciding how to treat aortic valve problems.”

Investigators sought to evaluate the incidence of in-hospital mortality associated with new-onset AFib after TAVI and AVR. Using the National Inpatient Sample, investigators identified a total of 48,715 TAVI hospitalizations and 122,765 AVR hospitalizations between Jan. 1, 2012 and Sept. 30, 2015.

To be a part of the 171,480 hospitalizations included in the study, study participants needed to be 18 or older, have no presence of AFib upon admission, could not have congenital aortic stenosis, could not have mitral valve repair or replacement during the same admission.

Investigators identified a total of 24,560 hospitalizations for TAVI with new-onset AFib and 61,530 for AVR with new-onset AFib. Conversely, there were 24,155 hospitalizations for TAVI without new-onset atrial fibrillation and 61,235 hospitalizations for AVR without new-onset atrial fibrillation.

Compared to those without new-onset atrial fibrillation, those hospitalized for TAVI and AVR with new-onset atrial fibrillation had a greater prevalence of blood transfusions, chronic kidney disease, chronic pulmonary disease, congestive heart failure, coronary artery disease, history of valve surgery, and peripheral vascular disease. In multivariable adjusted analyses, TAVI hospitalizations with new-onset AFib had 57% higher chance of in-hospital mortality compared with those without new-onset AFib. Additionally, in a multivariable adjusted analysis, AVR hospitalizations with new-onset AFib had 36% higher risk of in-hospital mortality.

Based upon the findings of their study, authors concluded that new-onset AFib is a common occurrence among hospitalizations for both AVR and TAVI. Authors also noted that new-onset AFib is associated with a marked increase in incident length of stay, stroke, and in-hospital mortality.

This study, titled “Evaluation of the Incidence of New-Onset Atrial Fibrillation After Aortic Valve Replacement,” is published in JAMA Internal Medicine.