The Impact of Beta- and Calcium Channel Blockers on Post-procedural Atrial Fibrillation and In-hospital Clinical Outcomes in Patients Who Underwent Trans-catheter Aortic Valve Replacement

Background:
Pre-procedural introduction of Beta-Blockers (BB) have been proven to reduce the incidence of post procedural atrial fibrillation (afib) in patients undergoing surgical aortic valve replacement. We aim to clarify the impact of pre-procedural BB and/or Calcium Channel Blockers (CCB) on post procedural afib and clinical outcomes in patients with severe aortic stenosis (AS) who are undergoing Trans-catheter Aortic Valve Replacement (TAVR).

Methods:
We performed a retrospective analysis of patients with severe symptomatic AS who underwent TAVR at our institution. Electronic medical records were reviewed to identify patients who were on BB and/or CCB (BB/CCB) as outpatient and/or inpatient prior to TAVR procedure. In addition, patients with history of afib were identified. After excluding patients with afib, patients were categorized into following two groups; 1) Patients on pre-procedure BB/CCB and 2) Control patients. Primary endpoint was the incidence of post TAVR afib during index admission. Secondary endpoint was major adverse cardiac events (MACE) identified as mortality, cardiac arrest, myocardial infarction, and stroke. Additionally, 30-day readmission was compared between the two groups.

Results:
After excluding 107 patients with history of afib, a total 219 patients were included in the final analysis, of which 114 patients (52.1%) were on BB/CCB as an outpatient. Of the 114 patients, 105 patients (92.1 %) continued to take BB/CCB as inpatient prior to TAVR. Patients on BB/CCB as inpatient were more likely to have history of coronary artery disease (78.1% vs. 64.0 %, p=0.022). Left ventricular ejection fraction was lower among patients on BB/CCB as inpatient (55 % [45-60] vs. 60% [50-60], p=0.023). Although the incidence of post TAVR afib was comparable between the two groups (8.6% vs. 9.6%, p=0.78), patients on BB/CCB had a lower rate of in-hospital MACE (1.9% vs. 10.5%, p=0.009). The rate of 30-day readmission was lower among patients on BB/CCB as inpatient (3.8% vs. 15.3%, p=0.004).

Conclusions:
In our cohort of patients who underwent TAVR, pre-TAVR BB/CCB was not associated with a lower incidence of post TAVR afib. However, patients on BB/CCB as inpatient had a lower rate of in-hospital MACE and 30-day readmission.