Author + information
- Daniel Zarama,
- M. Chadi Alraies,
- Samit Roy and
- Ganesh Raveendran
The relative incidences of new-onset AF post-TAVR and their effects on post-operative ischemic stroke versus SAVR have not been well described. We sought to compare the incidences of new-onset AF after TAVR and to determine their potential relationship to post-interventional stroke versus SAVR.
Retrospective-cohort study examining 117 patients with AVR for aortic stenosis and free of pre-existing AF between January 2011 and June 2014 utilizing clinical histories from procedure until 6-month follow-up. New-onset AF defined as transient AF episodes during the first 72 hours or any diagnosis of paroxysmal, chronic, or persistent AF after the 72 hour window. Continuous variables analyzed using a t-test or Wilcoxon rank sum test, and categorical variables analyzed using chi-squared or Fisher’s exact test.
117 AVR cases occurred consisting of 53 TAVRs and 64 SAVRs. 27 TAVR patients underwent TA and 26 TF. Overall, 29.9% of patients developed AF. 22.6% of TAVR patients and 35.9% of SAVR patients developed new-onset AF. 18.5% of TA-TAVR and 26.9% of TF-TAVR patients developed AF. 24 AF episodes occurred within 72 hours; 29.2% within 24 hours, 20.8% between 24-48 hours, and 50.0% between 48-72 hours. Six patients had strokes; 4 post-TAVR (7.6%) and 2 post-SAVR (3.2%) [p=0.41].
We found no difference in AF incidence between the three approaches. TA-TAVR has a statistically significant CVA reduction versus TF-TAVR and SAVR (p=0.039). TF-TAVR has the highest AF and CVA incidence. Delivery technique and the presence of aortic arch atheroma may contribute to higher CVA rates. We found no definite relationship between new-onset AF and CVA.