Higher Incidence of Atrial fibrillation and Permanent Pacemaker Implantation in Cancer Survivors with Severe Aortic Stenosis Undergoing Transcatheter Aortic Valve Replacement

Agrawal, Nikhil

Higher Incidence of Atrial fibrillation and Permanent Pacemaker Implantation in Cancer Survivors with Severe Aortic Stenosis Undergoing Transcatheter Aortic Valve Replacement

Monday, May 20, 2019

Belmont Ballroom 2-3 (The Cosmopolitan of Las Vegas)

Nikhil Agrawal, MD , State University Of New York At Buffalo, Buffalo, NY

Sharma Kattel, MD, PhD , State University Of New York At Buffalo, Buffalo, NY

Ankita Kapoor, MBBS , State University Of New York At Buffalo, Buffalo, NY

Vasvi Singh, MD , State University Of New York At Buffalo, BUFFALO, NY

Ashutosh Sharma, MD , State University Of New York At Buffalo, BUFFALO, NY

Kristopher Attwood, PhD , State University Of New York At Buffalo, BUFFALO, NY

Saraswati Pokharel, MD, Phd , State University Of New York At Buffalo, BUFFALO, NY

Vijay S. Iyer, M.D., Ph.D., FSCAI , Great Lakes Cardiovascular, East Amherst, NY

Umesh Sharma, MD, PhD , State University Of New York At Buffalo, Buffalo, NY

Background:
Conduction abnormalities including high degree atrioventricular block and sick sinus syndrome have been previously described in patients with prior mediastinal radiation (XRT). With increasing incidence of radiation induced valvular heart diseases and cardiovascular co-morbidities in cancer survivors, we examined the burden of atrial fibrillation and permanent pacemaker-requiring atrioventricular conduction abnormalities in cancer survivors with prior radiation exposure undergoing transcatheter aortic valve replacement (TAVR).

Methods:
We studied 610 patients (XRT: 75; non-XRT: 535) with severe symptomatic aortic stenosis undergoing TAVR at our institution from 2012 to 2017. In addition to electrocardiographic and echocardiographic data, we examined demographic, clinical and outcome data before and up to mean follow-up of 17 months after TAVR. We used logistic regression analysis to identify the major risk factors for onset of arrhythmias post TAVR.

Results:
In the XRT group, the median Society of Thoracic Surgeons (STS) score was 8.1 (interquartile: 5.4-11) while mean left ventricular ejection fraction (%), left ventricular stroke volume index (cc/m²), and mean aortic valve gradient (mmHg) were 55±12, 40±13 and 43±1 respectively. Significantly higher incidence of new-onset atrial fibrillation was noted in XRT group (XRT-48 % vs non-XRT-2.4%, p<0.0001). Notably, 15 out of 75 (20%) patients in the XRT group developed new conduction abnormalities requiring permanent pacemaker implantation compared to 49 out of 535 (9.1%) in the comparison group (p< 0.007). On logistic regression analysis, prior XRT remains the major risk factor (OR: 88.8,95% CI: 33.8-233.4; P:<0.001) for new onset atrial fibrillation post TAVR.

Conclusions:
Severe aortic stenosis patients with prior mediastinal radiation exposure as a part of curative cancer therapy demonstrate significantly higher incidence of atrial fibrillation and need for permanent pacemaker implantation post TAVR.