- 作者：Tanyanan Tanawuttiwat ; MD&lowast ; ; Brian P. O'Neill ; MD&dagger ; ; Mauricio G. Cohen ; MD&lowast ; ; Orawee Chinthakanan ; MD&Dagger ; ; Alan W. Heldman ; MD&lowast ; ; Claudia A. Martinez ; MD&lowast ; ; Carlos E. Alfonso ; MD&lowast ; ; Raul D. Mitrani ; MD&lowast ; ; Conrad J. Macon ; MD§ ; ; Roger G. Carrillo ; MD鈥?/sup> ; Donald B. Williams ; MD鈥?/sup> ; William W. O'Neill ; MD¶ ; ; Robert J. Myerburg ; MD&lowast ; ; rmyerbur@med.miami.edu" class="auth_mail
- 关键词：atrial fibrillation ; transcatheter aortic valve replacement
- 刊名：Journal of the American College of Cardiology
- 出版年：22 April, 2014
- 年：2014
- 卷：63
- 期：15
- 页码：1510-1519
- 全文大小：537 K
Objectives
This study sought to determine the incidence of new-onset atrial fibrillation (AF) associated with different methods of isolated aortic valve replacement (AVR)鈥攖ransfemoral (TF), transapical (TA), and transaortic (TAo) catheter-based valve replacement and conventional surgical approaches.Background
The relative incidences of AF associated with the various access routes for AVR have not been well characterized.
Methods
In this single-center, retrospective cohort study, we evaluated a total of 231 consecutive patients who underwent AVR for degenerative aortic stenosis (AS) between March 2010 and September 2012. Patients with a history of paroxysmal, persistent, or chronic AF, with bicuspid aortic valves, and patients who died within 48 h after AVR were excluded. A total of 123 patients (53% of total group) qualified for inclusion. Data on documented episodes of new-onset AF, along with all clinical, echocardiographic, procedural, and 30-day follow-up data, were collated.
Results
AF occurred in 52 patients (42.3%). AF incidence varied according to the procedural method. AF occurred in 60% of patients who underwent surgical AVR (SAVR), in 53% after TA-TAVR, in 33% after TAo-TAVR cases, and 14% after TF-TAVR. The episodes occurred at a median time interval of 53 (25th to 75th percentile, 41 to 87) h after completion of the procedure. Procedures without pericardiotomy had an 82% risk reduction of AF compared with those with pericardiotomy (adjusted odds ratio: 0.18; 95% confidence interval: 0.05 to 0.59).
Conclusions
AF was a common complication of AVR with a cumulative incidence of >40% in elderly patients with degenerative AS who underwent either SAVR or TAVR. AF was most common with SAVR and least common with TF-TAVR. Procedures without pericardiotomy were associated with a lower incidence of AF.