Incidence of Stroke and Anticoagulation Management in Patients with New-Onset Atrial Fibrillation Following Transcatheter Aortic Valve Replacement

Chen, Kai

Incidence of Stroke and Anticoagulation Management in Patients with New-Onset Atrial Fibrillation Following Transcatheter Aortic Valve Replacement

Wednesday, May 22, 2019

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

Kai Chen , University of Miami Palm Beach Regional Campus, Atlantis, FL

Abdulah Alrifai , University of Miami Palm Beach Regional Campus, Atlantis, FL

Jesus E. Pino, M.D. , University of Miami/ JFK Medical Center Palm Beach Regional Consortium, Atlantis, FL

Mohamad Kabach , University of Miami Palm Beach Regional Campus, Atlantis, FL

Elie Donath, M.D. , University of Miami/ JFK Medical Center Palm Beach Regional Consortium, Atlantis, FL

Lawrence Lovitz, M.D. , JFK Medical Center, Atlantis, FL

Mark Rothenberg , University of Miami Palm Beach Regional Campus, Atlantis, FL

Roberto J. Cubeddu, M.D., FSCAI , Cleveland Clinic Florida, Weston, FL

Robert Chait, M.D. , University of Miami Palm Beach Regional Campus, Atlantis, FL

Marcos Nores, MD , JFK Medical Center, Atlantis, FL

Background:
Post-procedure new-onset atrial fibrillation (AF) has been associated with adverse outcomes in patients undergoing TAVR. However not all patients with new-onset AF are discharged on anticoagulation, and the appropriate management is unclear.

Methods:
This is a retrospective cohort study of patients with new-onset AF following TAVR in a tertiary cardiovascular center. Patients were divided into two groups based on the duration of the AF: Transient-AF (self-limited or terminated before discharge), and Ongoing-AF (remained in AF at discharge). Outcomes include 30-day and one-year mortality, 30-day stroke rate, acute kidney injury and hospital stay.

Results:
Out of 572 patients that underwent TAVR between April 2012 and January 2017 in our institution, 294 did not have history of AF prior to TAVR and 39 of these patients (13%) developed new-onset AF (See table 1 for baseline characteristics). Twenty-nine patients (74%) developed transient-AF and ten patients (26%) had ongoing-AF at the time of discharge. Seven patients (70%) with ongoing-AF were discharged with an oral anticoagulant (OAC) vs. only one patient (3.4%) in the transient-AF group. Thirty-day stroke rate was higher in patients with transient-AF vs. Ongoing-AF and no new-onset AF groups (14.8% vs. 3.5% vs. 0%, p=0.02). See table 1 for outcomes.

Conclusions:
This study suggests that all patients with post TAVR new-onset AF would benefit from OAC, regardless of AF duration at the time of discharge.