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

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.