The broad enthusiasm for TAVI (transcatheter aortic valve implantation) as it enters the marketplace has been partially offset by concerns about an increased risk of 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 new 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. 31.9% (44 patients) developed new-onset AF while in the hospital at a median time of 48 hours after the procedure. More than 80% of the AF episodes occurred within the first three 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 of AF. TAVI patients who developed AF had a higher rate of stroke or systemic embolism at 30 days and one year, but no significant differences in mortality were observed 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.