The prevalence and impact of atrial fibrillation (AF) versus sinus rhythm (SR) on
outcomes in very severe aortic stenosis (vsAS) of the native valve is unknown. The
aim of the study was to determine the prognostic significance of AF in vsAS. A total
of 563 patients with vsAS (transaortic valve peak velocity ≥5 m/s) and left ventricular
ejection fraction ≥50% were identified retrospectively. Patients were divided by rhythm
at the time of index transthoracic echocardiogram (AF: n = 50 [9%] vs SR: n = 513
[91%]). Patients with AF were older (83.1 ± 7.5 vs 72.5 ± 12.2 y, p <0.001) and had
no difference in gender distribution (p = 0.49) but had a higher Charlson co-morbidity
index (2 [1,3] vs 1 [0,2], p = 0.01). There was no difference in transaortic peak
velocity (5.3 ± 0.3 m/s vs 5.4 ± 0.4 m/s, p = 0.13) and left ventricular ejection
fraction was comparable (63 ± 7 vs 66 ± 7%, p = 0.01). Age-, gender-, Charlson co-morbidity
index-, and time-dependent aortic valve replacement (AVR)-adjusted overall mortality
at 5 years was significantly higher in patients with AF than patients with SR (hazard
ratio [HR] 1.88 [1.23 to 2.85], p = 0.003). AVR was associated with improved survival
(HR = 0.30 [0.22 to 0.42], p <0.001), with no statistically significant interaction
of AVR and rhythm (p = 0.36). Outcomes were also compared in the 2 SR:1 AF propensity-matched
analyses (100 SR: 50 AF), with matching done according to age, gender, clinical co-morbidities,
and year of echocardiogram. In the propensity-matched analysis, age-, gender-, and
time-dependent AVR-adjusted all-cause mortality was higher in AF (HR 2.32 [1.41 to
3.82], p <0.001). In conclusion, AF was not uncommon in vsAS and identified a subset
of patients at a much higher risk of mortality without AVR.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to American Journal of CardiologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- 2020 ACC/AHA guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association joint committee on clinical practice guidelines.Circulation. 2021; 143: e35-e71
- Natural history of very severe aortic stenosis.Circulation. 2010; 121: 151-156
- Natural history of asymptomatic severe aortic stenosis and the association of early intervention with outcomes: a systematic review and meta-analysis.JAMA Cardiol. 2020; 5: 1102-1112
- Outcomes of patients with asymptomatic aortic stenosis followed up in heart valve clinics.JAMA Cardiol. 2018; 3: 1060-1068
- Asymptomatic Severe aortic stenosis in the Elderly.J Am Coll Cardiol Imaging. 2017; 10: 43-50
- Clinical outcomes in non-surgically managed patients with very severe versus severe aortic stenosis.Heart. 2011; 97: 2029-2032
- Risk stratification of severe aortic stenosis with preserved left ventricular ejection fraction using peak aortic jet velocity: an outcome study.Circ Cardiovasc Imaging. 2017; 10e006760
- Prevalence of comorbidities and associated cardiac diseases in patients with valve aortic stenosis. Potential implications for the decision-making process.Int J Cardiol. 2012; 159: 94-99
Kubala M, Bohbot Y, Rusinaru D, Maréchaux S, Diouf M, Tribouilloy C. Atrial fibrillation in severe aortic stenosis: prognostic value and results of aortic valve replacement [published online November 29, 2021]. J Thorac Cardiovasc Surg https://doi.org/10.1016/j.jtcvs.2021.11.055.
- Determinants and prognosis of atrial fibrillation in patients with aortic stenosis.Am J Cardiol. 2015; 116: 1541-1546
- Atrial fibrillation and aortic stenosis: impact on clinical outcomes among patients undergoing transcatheter aortic valve implantation.Circ Cardiovasc Interv. 2013; 6: 77-84
- Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice.J Am Soc Echocardiogr. 2009; 22: 1-23
- A new method of classifying prognostic comorbidity in longitudinal studies: development and validation.J Chronic Dis. 1987; 40: 373-383
- CURRENT AS Registry Investigators. Sudden death in patients with severe aortic stenosis: observations from the CURRENT AS registry.J Am Heart Assoc. 2018; 7e008397
- Atrial fibrillation is not an independent predictor of outcome in patients with aortic stenosis.Heart. 2020; 106: 280-286
- Prevalence and impact of atrial fibrillation in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement: an analysis from the SOURCE XT prospective multicenter registry.JACC Cardiovasc Interv. 2016; 9: 937-946
- Atrial fibrillation is associated with increased mortality in patients undergoing transcatheter aortic valve replacement: insights from the placement of aortic transcatheter valve (PARTNER) trial.Circ Cardiovasc Interv. 2016; 9e002766
- Systematic review and meta-analysis on the impact of preoperative atrial fibrillation on short- and long-term outcomes after aortic valve replacement.J Cardiovasc Surg (Torino). 2017; 58: 943-950
- High prevalence of severe aortic stenosis in low-flow state associated with atrial fibrillation.Circ Cardiovasc Imaging. 2021; 14e012453
- Averaged transaortic mean gradient during atrial fibrillation does not accurately reflect aortic stenosis severity.J Am Soc Echocardiogr. 2022; 35: 885-887
- Doppler mean gradient is discordant to aortic valve calcium scores in patients with atrial fibrillation undergoing transcatheter aortic valve replacement.J Am Soc Echocardiogr. 2022; 35: 116-123
Article info
Publication history
Published online: December 09, 2022
Received in revised form:
October 28,
2022
Received:
September 21,
2022
Footnotes
Funding: none.
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
