The presence of atrial fibrillation (AF) after transcatheter aortic valve replacement (TAVR) may be associated with changes in left ventricular (LV) mass index, according to a prospective observational study published in Clinical Research in Cardiology.

Patients (N=213) with severe symptomatic aortic stenosis undergoing TAVR at a single center in Germany between 2015 and 2020 were recruited for this study. AF was defined as previously identified (n=88) or newly diagnosed by 12-lead electrocardiograph directly after TAVR (n=7). Clinical outcomes and adverse events were assessed through 36 months.

Patients with vs without AF were significantly older (82±7 vs 79±8 years, respectively; P =.02), and a greater percentage had chronic renal failure (57% vs 39%, respectively; P =.02), prescribed beta-blockers (83% vs 67%, respectively; P =.007), had greater left atrial diameter (48±11 vs 43±7 mm, respectively; P =.004), right ventricular diameter (33±4 vs 31±4 mm, respectively; P =.02), higher moderate mitral regurgitation (21% vs 12%, respectively; P =.07), moderate tricuspid regurgitation (16% vs 2%, respectively; P <.001), lower aortic valve mean gradient (41±13 mm Hg vs 45±14 mm Hg, respectively; P =.02), and tricuspid annular plane systolic excursion (20±4 vs 22±5 mm, tricuspid a; P =.003). During TAVR no procedural differences were observed on the basis of AF.


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At follow-up, patients with sinus rhythm exhibited increased relative change to LV mass index (–9±29%) compared with patients who had AF (–2±28%; P =.04). LV ejection fraction was lower among patients with vs without AF (52±11% vs 56±7%, respectively; P =.004) and LV end-diastolic diameter was greater (47±8 mm vs 44±6 mm, respectively; P =.003).

Change in LV mass index was associated with AF (ß, 0.076; 95% CI, 0.001-0.150; P =.04) and baseline LV mass index (ß, –0.002; 95% CI, –0.002 to –0.001; P <.001).

Events other than death and rehospitalization were less likely among patients with AF with and without or did not have LV mass index regression up to 36 months (hazard ratio [HR], 1.91; 95% CI, 1.06-3.44; P =.03 and HR, 1.95; 95% CI, 1.03-3.69; P =.04, respectively). Risk for event free of death alone was not significantly associated with any of the patient groups.

This study may have been limited by the choice to not use magnetic resonance imaging or biopsy for the diagnosis of LV remodeling.

“The present study showed for the first time that AF has a strong impact on LV remodeling after TAVR,” concluded the study authors.

Reference

Ledwoch J, Fröhlich C, Olbrich I, et al. Impact of sinus rhythm versus atrial fibrillation on left ventricular remodeling after transcatheter aortic valve replacement. Clin Res Cardiol. Published online February 10, 2021. doi:10.1007/s00392-021-01810-5