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J. Lopez Aguilera, J.M. Segura Saint-Gerons, J.J. Sanchez Fernandez, F. Mazuelos Bellido, J. Suarez De Lezo Herreros De Tejada, S. Ojeda Pineda, M. Romero Moreno, D. Mesa Rubio, D.J. Pavlovic, L. Pardo, S. Rodriguez Diego, C. Ferreiro, J. Chavarria, J. Suarez De Lezo Cruz Conde, M. Pan Alvarez-Ossorio, 65
Effect of atrial fibrillation in the long-term follow-up of patients with severe aortic stenosis treated with the CoreValve prosthesis, European Heart Journal, Volume 38, Issue suppl_1, August 2017, ehx501.65, https://doi.org/10.1093/eurheartj/ehx501.65Close - Share Icon Share
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Purpose: To analyze the influence of previous atrial fibrillation on the outcome of patients with degenerative aortic stenosis undergoing transcatheter aortic valve implantation.
Methods: Between April 2008 and December 2016, 295 patients with aortic stenosis underwent transcatheter aortic CoreValve implantation; 213 (78%) were in sinus rhythm (group I), and 82 (22%) had permanent (n=50) or paroxysmal (n=30) atrial fibrillation (group II). Patients were followed-up at 1-month, 6-month, 12-month, and yearly thereafter. We defined major events as: death from any cause, stroke or readmission for heart failure.
Results: The mean age was 78±4 years. Patients were followed-up for 38±28 months. There were no significant differences in baseline characteristics among groups in terms of age, incidence of diabetes, hypertension, coronary artery disease, chronic pulmonary disease, prior stroke or chronic renal failure. Baseline peak systolic pulmonary pressure and Euroscore logistic were also higher in group II patients (50±15 vs 44±16 mmHg; P<0.05), (20±12 vs 16±11), respectively. However, there were no differences between groups in left ventricular ejection fraction, peak aortic gradient or aortic valve area. Both groups of patients underwent similar treatment procedures, with no differences in terms of valve size, need for post-dilation or permanent pacemaker implantation. Patients in sinus rhythm were discharged with aspirin and clopidogrel, while patients with atrial fibrillation received oral anti-coagulation, plus aspirin and/or clopidogrel. Group II (patients with atrial fibrillation), had a worse prognosis in term of all-cause mortality (50.6% vs 91.9%; P<0.05), and morbidity, with an increased risk of having a stroke (14.6% vs 39.2%; P<0.05) or readmission for heart failure (31.3% vs 78.1%; P<0.05), in the long-term follow-up (Figure 1).
