Associations between new-onset postoperative atrial fibrillation and changes in left ventricular mass index in patients undergoing transcatheter aortic valve replacement

Abstract

Background New-onset postoperative atrial fibrillation (POAF) is common after transcatheter aortic valve replacement (TAVR). At present, the impact of POAF on cardiac remodeling after TAVR has not been thoroughly studied.
Objectives To investigate the impact of POAF on cardiac remodeling and its association with clinical outcomes after TAVR.
Methods 601 patients undergoing TAVR for severe aortic stenosis were evaluated. Of these, 253 patients were identified to have POAF, which was categorized as normal left ventricular mass index (LVMI) in 54 (21%) and high LVMI in 199 (79%). The primary endpoint was a composite of all-cause death, heart failure rehospitalization and disabling stroke. Reverse remodeling was assessed by transthoracic echocardiography.
Results In POAF patients, the 3-year cumulative incidence of primary composite outcome in the high LVMI subgroup was significantly higher than that in the normal LVMI subgroup (9.3 ± 3.3% vs. 13.5 ± 3.9%; p = 0.02). The incidence of LVMI regression after TAVR was lower in patients with POAF than in those without (65.6 ± 3.0% vs. 82.6 ± 2.7% at 3 years; p = 0.029). Furthermore, the 3-year cumulative incidence of the primary composite outcome and cardiovascular death was highest in the group of POAF without LVMI regression. Baseline LVMI (β = -1.73, p < 0.001) and POAF (β = -1.46, p < 0.001) were independent predictors of change in LVMI at one year.
Conclusions Patients with POAF had less LVMI regression and impaired cardiac reverse remodeling after TAVR, which increased the incidence of all-cause death and heart failure rehospitalization. Therefore, clinicians should be more proactive in monitoring and treating POAF after TAVR.

Keywords: Transcatheter aortic valve replacement; Aortic stenosis; Postoperative atrial fibrillation; Cardiac reverse remodeling.