TAVR outcomes after 1 year much worse for patients with valvular AFib

Atrial Fibrillation (AFib) and mitral stenosis are both known to increase a transcatheter aortic valve replacement (TAVR) patient’s risk of experiencing an adverse outcome. But if the patient has both—known as valvular AFib—is the risk even greater that something could go wrong?

Researchers explored that very question, sharing their findings in JACC: Cardiovascular Interventions.

“AFib has been categorized into nonvalvular AFib and valvular AFib on the basis of etiology.,” wrote lead author Taishi Okuno, MD, University of Bern in Switzerland, and colleagues. “Valvular AFib is conventionally defined as AFib in the setting of concomitant mitral stenosis or the presence of a mitral valve prosthesis. It denotes an increased risk for thromboembolic events compared with nonvalvular AFib, and patients with valvular AFib have been excluded from most trials comparing direct oral anticoagulant agents. A differentiation of the type of AF in patients undergoing TAVR may have implications on clinical outcomes and post-procedural management.”

Okuno et al. tracked data from more than 1,400 TAVR patients treated at a single facility in Switzerland from August 2007 to June 2018. While 25.5% of patients had nonvalvular AFib, another 6% had valvular AFib.  

The study’s primary endpoint—a composite of cardiovascular death or disabling stroke at one year after TAVR—occurred in 24.2% of patients with valvular AFib, 14.5% of patients with nonvalvular AFib and 9.3% of patients with no AFib.

“The presence of valvular AFib in patients undergoing TAVR increased the risk for cardiovascular death or disabling stroke compared with both no AFib and nonvalvular AFib,” the authors wrote. “Identification of patients with valvular AFib may refine risk stratification in patients undergoing TAVR.”

The team did note that their research had certain limitations. Patients were only enrolled if diagnostic echocardiography results were available, for instance, which “may have resulted in selection bias.” Also, some patients could have had AFib go undiagnosed.

“Finally, the reported findings are based on nonrandomized prospective registry data of patients undergoing TAVR; in the absence of a control arm of patients undergoing surgical aortic valve replacement, our findings are of limited relevance for the selection of the optimal treatment strategy for individual patients,” the authors concluded.

Click here for the full study.