Clinical Outcomes in Atrial Fibrillation Patients Undergoing Transcatheter Aortic Valve Replacement With Contemporary Devices

Siddhartha Mengi; Pedro Cepas-Guillén; Julien Ternacle; Marina Urena; Alberto Alperi; Asim N. Cheema; Gabriela Veiga-Fernandez; Luis Nombela-Franco; Victoria Vilalta; Giovanni Esposito; Francisco Campelo-Parada; Ciro Indolfi; Maria del Trigo; Antonio Muñoz-Garcia; Nicolas Maneiro; Lluís Asmarats; Ander Regueiro; David Del Val; Vicenç Serra; Vincent Auffret; Lionel Leroux; Thomas Modine; Jules Mesnier; Gaspard Suc; Pablo Avanzas; Effat Rezaei; Victor Fradejas-Sastre; Gabriela Tirado-Conte; Eduard Fernández-Nofrerias; Domenico Angellotti; Thibaut Guitteny; Sabato Sorrentino; Juan Francisco Oteo; Felipe Díez-Delhoyo; Lola Gutiérrez-Alonso; Pablo Vidal-Calés; Fernando Alfonso; Andrea Monastyrski; Maxime Nolf; Marisa Avvedimento; Josep Rodés-Cabau

doi:10.1016/j.cjca.2024.12.007

Clinical Outcomes in Atrial Fibrillation Patients Undergoing Transcatheter Aortic Valve Replacement With Contemporary Devices

Siddhartha Mengi, Pedro Cepas-Guillén, Julien Ternacle, Marina Urena, Alberto Alperi, Asim N. Cheema, Gabriela Veiga-Fernandez, Luis Nombela-Franco, Victoria Vilalta, Giovanni Esposito, Francisco Campelo-Parada, Ciro Indolfi, Maria del Trigo, Antonio Muñoz-Garcia, Nicolas Maneiro, Lluís Asmarats, Ander Regueiro, David Del Val, Vicenç Serra, Vincent AuffretLionel Leroux, Thomas Modine, Jules Mesnier, Gaspard Suc, Pablo Avanzas, Effat Rezaei, Victor Fradejas-Sastre, Gabriela Tirado-Conte, Eduard Fernández-Nofrerias, Domenico Angellotti, Thibaut Guitteny, Sabato Sorrentino, Juan Francisco Oteo, Felipe Díez-Delhoyo, Lola Gutiérrez-Alonso, Pablo Vidal-Calés, Fernando Alfonso, Andrea Monastyrski, Maxime Nolf, Marisa Avvedimento, Josep Rodés-Cabau

Research output: Contribution to journal › Article › peer-review

Abstract

Background: Atrial fibrillation (AF) has been identified as a marker of advanced cardiac damage in patients with aortic stenosis. However, the factors associated with poorer outcomes among AF patients in contemporary transcatheter aortic valve replacement (TAVR) practice, particularly regarding mortality and heart failure (HF)-related hospitalizations, remain largely unknown. Methods: In this multicenter study, we assessed consecutive patients with a history of AF and evaluated the clinical outcomes of those who underwent TAVR with newer generation devices using either balloon- or self-expandable valves. Results: A total of 3476 patients were included in the study. After a median follow-up of 2 (interquartile range, 1-4) years, 36.1% patients had died, with 51.5% of deaths being cardiovascular-related, including 15.6% from HF. HF-related hospitalizations post-TAVR accounted for 34.8% of all hospitalizations and were associated with a higher mortality risk (hazard ratio [HR], 1.54; 95% confidence interval [CI], 1.32-1.81; P < 0.001). Permanent AF was identified as an independent predictor of all-cause mortality or HF-related hospitalizations (HR, 1.25; 95% CI, 1.10-1.40; P < 0.001), as did other baseline characteristics, including chronic kidney disease (HR, 1.23; 95% CI, 1.09-1.38; P = 0.001), anemia (HR, 1.21; 95% CI, 1.07-1.36; P = 0.002), and New York Heart Association functional class III or IV (HR, 1.13; 95% CI, 1.01-1.27; P = 0.045). In addition, early postprocedural complications, including stroke and bleeding, also significantly increased the risk of mortality (HR, 5.52; 95% CI, 3.12-9.79; P < 0.001) and HF-related hospitalizations (HR, 1.17; 95% CI, 1.03-1.33; P = 0.014). Conclusions: AF patients exhibited a high risk of mortality and HF-related hospitalizations in a contemporary TAVR cohort. Several baseline comorbidities and periprocedural complications, along with permanent (vs paroxysmal) AF, were associated with poorer outcomes. These findings confirm the negative impact of AF despite the continued improvements in TAVR technology and underscore the importance of early intervention and optimization of HF management to improve outcomes in this high-risk population.

Original language	English
Journal	Canadian Journal of Cardiology
DOIs	https://doi.org/10.1016/j.cjca.2024.12.007
State	Accepted/In press - 2025
Externally published	Yes

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10.1016/j.cjca.2024.12.007

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Mengi, S., Cepas-Guillén, P., Ternacle, J., Urena, M., Alperi, A., Cheema, A. N., Veiga-Fernandez, G., Nombela-Franco, L., Vilalta, V., Esposito, G., Campelo-Parada, F., Indolfi, C., del Trigo, M., Muñoz-Garcia, A., Maneiro, N., Asmarats, L., Regueiro, A., Del Val, D., Serra, V., ... Rodés-Cabau, J. (Accepted/In press). Clinical Outcomes in Atrial Fibrillation Patients Undergoing Transcatheter Aortic Valve Replacement With Contemporary Devices. Canadian Journal of Cardiology. https://doi.org/10.1016/j.cjca.2024.12.007

@article{e6425a72b1cd4bc8a31bed648478f401,

title = "Clinical Outcomes in Atrial Fibrillation Patients Undergoing Transcatheter Aortic Valve Replacement With Contemporary Devices",

abstract = "Background: Atrial fibrillation (AF) has been identified as a marker of advanced cardiac damage in patients with aortic stenosis. However, the factors associated with poorer outcomes among AF patients in contemporary transcatheter aortic valve replacement (TAVR) practice, particularly regarding mortality and heart failure (HF)-related hospitalizations, remain largely unknown. Methods: In this multicenter study, we assessed consecutive patients with a history of AF and evaluated the clinical outcomes of those who underwent TAVR with newer generation devices using either balloon- or self-expandable valves. Results: A total of 3476 patients were included in the study. After a median follow-up of 2 (interquartile range, 1-4) years, 36.1% patients had died, with 51.5% of deaths being cardiovascular-related, including 15.6% from HF. HF-related hospitalizations post-TAVR accounted for 34.8% of all hospitalizations and were associated with a higher mortality risk (hazard ratio [HR], 1.54; 95% confidence interval [CI], 1.32-1.81; P < 0.001). Permanent AF was identified as an independent predictor of all-cause mortality or HF-related hospitalizations (HR, 1.25; 95% CI, 1.10-1.40; P < 0.001), as did other baseline characteristics, including chronic kidney disease (HR, 1.23; 95% CI, 1.09-1.38; P = 0.001), anemia (HR, 1.21; 95% CI, 1.07-1.36; P = 0.002), and New York Heart Association functional class III or IV (HR, 1.13; 95% CI, 1.01-1.27; P = 0.045). In addition, early postprocedural complications, including stroke and bleeding, also significantly increased the risk of mortality (HR, 5.52; 95% CI, 3.12-9.79; P < 0.001) and HF-related hospitalizations (HR, 1.17; 95% CI, 1.03-1.33; P = 0.014). Conclusions: AF patients exhibited a high risk of mortality and HF-related hospitalizations in a contemporary TAVR cohort. Several baseline comorbidities and periprocedural complications, along with permanent (vs paroxysmal) AF, were associated with poorer outcomes. These findings confirm the negative impact of AF despite the continued improvements in TAVR technology and underscore the importance of early intervention and optimization of HF management to improve outcomes in this high-risk population.",

author = "Siddhartha Mengi and Pedro Cepas-Guill{\'e}n and Julien Ternacle and Marina Urena and Alberto Alperi and Cheema, {Asim N.} and Gabriela Veiga-Fernandez and Luis Nombela-Franco and Victoria Vilalta and Giovanni Esposito and Francisco Campelo-Parada and Ciro Indolfi and {del Trigo}, Maria and Antonio Mu{\~n}oz-Garcia and Nicolas Maneiro and Llu{\'i}s Asmarats and Ander Regueiro and {Del Val}, David and Vicen{\c c} Serra and Vincent Auffret and Lionel Leroux and Thomas Modine and Jules Mesnier and Gaspard Suc and Pablo Avanzas and Effat Rezaei and Victor Fradejas-Sastre and Gabriela Tirado-Conte and Eduard Fern{\'a}ndez-Nofrerias and Domenico Angellotti and Thibaut Guitteny and Sabato Sorrentino and Oteo, {Juan Francisco} and Felipe D{\'i}ez-Delhoyo and Lola Guti{\'e}rrez-Alonso and Pablo Vidal-Cal{\'e}s and Fernando Alfonso and Andrea Monastyrski and Maxime Nolf and Marisa Avvedimento and Josep Rod{\'e}s-Cabau",

note = "Publisher Copyright: {\textcopyright} 2024 Canadian Cardiovascular Society",

year = "2025",

doi = "10.1016/j.cjca.2024.12.007",

language = "English",

journal = "Canadian Journal of Cardiology",

issn = "0828-282X",

publisher = "Elsevier Inc.",

}

Mengi, S, Cepas-Guillén, P, Ternacle, J, Urena, M, Alperi, A, Cheema, AN, Veiga-Fernandez, G, Nombela-Franco, L, Vilalta, V, Esposito, G, Campelo-Parada, F, Indolfi, C, del Trigo, M, Muñoz-Garcia, A, Maneiro, N, Asmarats, L, Regueiro, A, Del Val, D, Serra, V, Auffret, V, Leroux, L, Modine, T, Mesnier, J, Suc, G, Avanzas, P, Rezaei, E, Fradejas-Sastre, V, Tirado-Conte, G, Fernández-Nofrerias, E, Angellotti, D, Guitteny, T, Sorrentino, S, Oteo, JF, Díez-Delhoyo, F, Gutiérrez-Alonso, L, Vidal-Calés, P, Alfonso, F, Monastyrski, A, Nolf, M, Avvedimento, M & Rodés-Cabau, J 2025, 'Clinical Outcomes in Atrial Fibrillation Patients Undergoing Transcatheter Aortic Valve Replacement With Contemporary Devices', Canadian Journal of Cardiology. https://doi.org/10.1016/j.cjca.2024.12.007

TY - JOUR

T1 - Clinical Outcomes in Atrial Fibrillation Patients Undergoing Transcatheter Aortic Valve Replacement With Contemporary Devices

AU - Mengi, Siddhartha

AU - Cepas-Guillén, Pedro

AU - Ternacle, Julien

AU - Urena, Marina

AU - Alperi, Alberto

AU - Cheema, Asim N.

AU - Veiga-Fernandez, Gabriela

AU - Nombela-Franco, Luis

AU - Vilalta, Victoria

AU - Esposito, Giovanni

AU - Campelo-Parada, Francisco

AU - Indolfi, Ciro

AU - del Trigo, Maria

AU - Muñoz-Garcia, Antonio

AU - Maneiro, Nicolas

AU - Asmarats, Lluís

AU - Regueiro, Ander

AU - Del Val, David

AU - Serra, Vicenç

AU - Auffret, Vincent

AU - Leroux, Lionel

AU - Modine, Thomas

AU - Mesnier, Jules

AU - Suc, Gaspard

AU - Avanzas, Pablo

AU - Rezaei, Effat

AU - Fradejas-Sastre, Victor

AU - Tirado-Conte, Gabriela

AU - Fernández-Nofrerias, Eduard

AU - Angellotti, Domenico

AU - Guitteny, Thibaut

AU - Sorrentino, Sabato

AU - Oteo, Juan Francisco

AU - Díez-Delhoyo, Felipe

AU - Gutiérrez-Alonso, Lola

AU - Vidal-Calés, Pablo

AU - Alfonso, Fernando

AU - Monastyrski, Andrea

AU - Nolf, Maxime

AU - Avvedimento, Marisa

AU - Rodés-Cabau, Josep

PY - 2025

Y1 - 2025

N2 - Background: Atrial fibrillation (AF) has been identified as a marker of advanced cardiac damage in patients with aortic stenosis. However, the factors associated with poorer outcomes among AF patients in contemporary transcatheter aortic valve replacement (TAVR) practice, particularly regarding mortality and heart failure (HF)-related hospitalizations, remain largely unknown. Methods: In this multicenter study, we assessed consecutive patients with a history of AF and evaluated the clinical outcomes of those who underwent TAVR with newer generation devices using either balloon- or self-expandable valves. Results: A total of 3476 patients were included in the study. After a median follow-up of 2 (interquartile range, 1-4) years, 36.1% patients had died, with 51.5% of deaths being cardiovascular-related, including 15.6% from HF. HF-related hospitalizations post-TAVR accounted for 34.8% of all hospitalizations and were associated with a higher mortality risk (hazard ratio [HR], 1.54; 95% confidence interval [CI], 1.32-1.81; P < 0.001). Permanent AF was identified as an independent predictor of all-cause mortality or HF-related hospitalizations (HR, 1.25; 95% CI, 1.10-1.40; P < 0.001), as did other baseline characteristics, including chronic kidney disease (HR, 1.23; 95% CI, 1.09-1.38; P = 0.001), anemia (HR, 1.21; 95% CI, 1.07-1.36; P = 0.002), and New York Heart Association functional class III or IV (HR, 1.13; 95% CI, 1.01-1.27; P = 0.045). In addition, early postprocedural complications, including stroke and bleeding, also significantly increased the risk of mortality (HR, 5.52; 95% CI, 3.12-9.79; P < 0.001) and HF-related hospitalizations (HR, 1.17; 95% CI, 1.03-1.33; P = 0.014). Conclusions: AF patients exhibited a high risk of mortality and HF-related hospitalizations in a contemporary TAVR cohort. Several baseline comorbidities and periprocedural complications, along with permanent (vs paroxysmal) AF, were associated with poorer outcomes. These findings confirm the negative impact of AF despite the continued improvements in TAVR technology and underscore the importance of early intervention and optimization of HF management to improve outcomes in this high-risk population.

AB - Background: Atrial fibrillation (AF) has been identified as a marker of advanced cardiac damage in patients with aortic stenosis. However, the factors associated with poorer outcomes among AF patients in contemporary transcatheter aortic valve replacement (TAVR) practice, particularly regarding mortality and heart failure (HF)-related hospitalizations, remain largely unknown. Methods: In this multicenter study, we assessed consecutive patients with a history of AF and evaluated the clinical outcomes of those who underwent TAVR with newer generation devices using either balloon- or self-expandable valves. Results: A total of 3476 patients were included in the study. After a median follow-up of 2 (interquartile range, 1-4) years, 36.1% patients had died, with 51.5% of deaths being cardiovascular-related, including 15.6% from HF. HF-related hospitalizations post-TAVR accounted for 34.8% of all hospitalizations and were associated with a higher mortality risk (hazard ratio [HR], 1.54; 95% confidence interval [CI], 1.32-1.81; P < 0.001). Permanent AF was identified as an independent predictor of all-cause mortality or HF-related hospitalizations (HR, 1.25; 95% CI, 1.10-1.40; P < 0.001), as did other baseline characteristics, including chronic kidney disease (HR, 1.23; 95% CI, 1.09-1.38; P = 0.001), anemia (HR, 1.21; 95% CI, 1.07-1.36; P = 0.002), and New York Heart Association functional class III or IV (HR, 1.13; 95% CI, 1.01-1.27; P = 0.045). In addition, early postprocedural complications, including stroke and bleeding, also significantly increased the risk of mortality (HR, 5.52; 95% CI, 3.12-9.79; P < 0.001) and HF-related hospitalizations (HR, 1.17; 95% CI, 1.03-1.33; P = 0.014). Conclusions: AF patients exhibited a high risk of mortality and HF-related hospitalizations in a contemporary TAVR cohort. Several baseline comorbidities and periprocedural complications, along with permanent (vs paroxysmal) AF, were associated with poorer outcomes. These findings confirm the negative impact of AF despite the continued improvements in TAVR technology and underscore the importance of early intervention and optimization of HF management to improve outcomes in this high-risk population.

UR - http://www.scopus.com/inward/record.url?scp=85217212397&partnerID=8YFLogxK

U2 - 10.1016/j.cjca.2024.12.007

DO - 10.1016/j.cjca.2024.12.007

M3 - Article

C2 - 39667494

AN - SCOPUS:85217212397

SN - 0828-282X

JO - Canadian Journal of Cardiology

JF - Canadian Journal of Cardiology

ER -

Clinical Outcomes in Atrial Fibrillation Patients Undergoing Transcatheter Aortic Valve Replacement With Contemporary Devices

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