CardioExchange Archive

CardioExchange, an NEJM practice community for medical professionals dedicated to improving cardiac patient care, was active from 2009 to 2015. CardioExchange fostered discussion between clinicians from across the globe.

December 14th, 2011

Study Examines New-Onset Atrial Fibrillation After TAVI

The broad enthusiasm for TAVI (transcatheter aortic valve implantation) as it enters the marketplace has been partially offset by concerns about an increased risk for stroke associated with the procedure. The role of one major cause of stroke, atrial fibrillation (AF), has not been the subject of close scrutiny. Now a study from Quebec, published in the Journal of the American College of Cardiology, provides new information about the rate of new-onset AF following TAVI.

Ignacio Amat-Santos and colleagues followed 138 patients with no history of AF who underwent TAVI. Some 32% (44 patients) developed new-onset AF while in the hospital at a median of 48 hours after the procedure. More than 80% of the AF episodes occurred within the first 3 days after implantation. One third of the episodes lasted less than an hour. Larger left atrial size and the transapical approach significantly increased the risk for AF. TAVI patients who developed AF had a higher rate of stroke or systemic embolism at 30 days and 1 year compared with those who did not develop AF, but no differences in mortality were observed between the groups in this small series.

In an accompanying editorial comment, Bernard Iung, Dominique Himbert, and Alec Vahanian write that the study “raises questions regarding the most appropriate antithrombotic therapy following TAVI,” but that the high number of patients with only a brief episode of AF does not support routine aggressive anticoagulation following any episode of AF.

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One Response to “Study Examines New-Onset Atrial Fibrillation After TAVI”

  1. Norman Silverman, md says:
    December 15, 2011 at 8:55 am

    this to me comes under the category of true, true, unrelated. it is obviously difficult to postulate how a transient perioperative episode of atrial fibrillation is etiologic for stroke occurence at 1 year. the fact that tavi is performed implies a high risk patient with an inherent propensity for cerebrovascular disease and stroke and for those requiring transventricular insertion, a documented atherosclerotic vascular burden. moreover, the device inself is probably more thrombogenic than other bioprostheses.

    Competing interests pertaining specifically to this post, comment, or both:
    none