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©2012 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Cardiol. Jan 26, 2012; 4(1): 8-14
Published online Jan 26, 2012. doi: 10.4330/wjc.v4.i1.8
Clinical and prognostic implications of atrial fibrillation in patients undergoing transcatheter aortic valve implantation
Pablo Salinas, Raúl Moreno, Luis Calvo, Santiago Jiménez-Valero, Guillermo Galeote, Angel Sánchez-Recalde, Teresa López-Fernández, Sergio Garcia-Blas, Diego Iglesias, Luis Riera, Isidro Moreno-Gómez, Jose María Mesa, Ignacio Plaza, Rocio Ayala, Rosa Gonzalez, José-Luis López-Sendón
Pablo Salinas, Raúl Moreno, Luis Calvo, Santiago Jiménez-Valero, Guillermo Galeote, Angel Sánchez-Recalde, Division of Interventional Cardiology, University Hospital La Paz, 28046 Madrid, Spain
Teresa López-Fernández, Unit of Echocardiography, University Hospital La Paz, 28046 Madrid, Spain
Sergio Garcia-Blas, Diego Iglesias, José-Luis López-Sendón, Department of Cardiology, University Hospital La Paz, 28046 Madrid, Spain
Luis Riera, Vascular Surgery, University Hospital La Paz, 28046 Madrid, Spain
Isidro Moreno-Gómez, Department of Cardiac Anaesthesia, University Hospital La Paz, 28046 Madrid, Spain
Jose María Mesa, Cardiac Surgery, University Hospital La Paz, 28046 Madrid, Spain
Ignacio Plaza, Department of Cardiology, Hospital Infanta Sofia, 28031 San Sebastian de los Reyes, Madrid, Spain
Rocio Ayala, Rosa Gonzalez, Department of Cardiology, Hospital de la Cruz Roja, 28003 Madrid, Spain
Author contributions: Salinas P and Moreno R designed the database, revised and analyzed the data and wrote the manuscript; Salinas P, Moreno R, Calvo L, Jiménez-Valero S, Galeote G and Sánchez-Recalde A performed the procedures; Garcia-Blas S and Iglesias D collected the data and contributed to the database; Riera L, Moreno-Gómez I and Mesa JM provided vascular surgery, anesthesia and cardiac surgery support for the procedures; Teresa Lopez-Fernandez provided echocardiographic monitoring during the procedures and cardiac imaging support; Plaza I, Ayala R and Gonzalez R provided clinical support and contributed to the clinical selection of the patients; López-Sendón JL provided support for the design of the study and revised the final manuscript.
Correspondence to: Raúl Moreno, MD, Division of Interventional Cardiology, University Hospital La Paz, Paseo La Castellana, 264, 28046 Madrid, Spain.
raulmorenog@terra.es
Telephone: +34-91-2071775 Fax: +34-91-2071775
Received: September 25, 2011
Revised: December 20, 2011
Accepted: December 27, 2011
Published online: January 26, 2012
AIM: To study a cohort of consecutive patients undergoing transcatheter aortic valve implantation (TAVI) and compare the outcomes of atrial fibrillation (AF) patients vs patients in sinus rhythm (SR).
METHODS: All consecutive patients undergoing TAVI in our hospital were included. The AF group comprised patients in AF at the time of TAVI or with history of AF, and were compared with the SR group. Procedural, echocardiographic and follow-up variables were compared. Likewise, the CHA2DS2-VASC stroke risk score and HAS-BLED bleeding risk score and antithrombotic treatment at discharge in AF patients were compared with that in SR patients.
RESULTS: From a total of 34 patients undergoing TAVI, 17 (50%) were allocated to the AF group, of whom 15 (88%) were under chronic oral anticoagulation. Patients in the AF group were similar to those in the SR group except for a trend (P = 0.07) for a higher logistic EuroSCORE (28% vs 19%), and a higher prevalence of hypertension (82% vs 53%) and chronic renal failure (17% vs 0%). Risk of both stroke and bleeding was high in the AF group (mean CHA2DS2-VASC 4.3, mean HAS-BLED 2.9). In the AF group, treatment at discharge included chronic oral anticoagulation in all except one case, and in association with an antiplatelet drug in 57% of patients. During a mean follow-up of 11 mo (maximum 32), there were only two strokes, none of them during the peri-procedural period: one in the AF group at 30 mo and one in the SR group at 3 mo. There were no statistical differences in procedural success, and clinical outcome (survival at 1 year 81% vs 74% in AF and SR groups, respectively, P = NS).
CONCLUSION: Patients in AF undergoing TAVI show a trend to a higher surgical risk. However, in our cohort, patients in AF did not have a higher stroke rate compared to the SR group, and the prognosis was similar in both groups.
