PMID- 24486264 OWN - NLM STAT- MEDLINE DCOM- 20140610 LR - 20210503 IS - 1558-3597 (Electronic) IS - 0735-1097 (Linking) VI - 63 IP - 15 DP - 2014 Apr 22 TI - New-onset atrial fibrillation after aortic valve replacement: comparison of transfemoral, transapical, transaortic, and surgical approaches. PG - 1510-9 LID - S0735-1097(14)00177-6 [pii] LID - 10.1016/j.jacc.2013.11.046 [doi] AB - OBJECTIVES: This study sought to determine the incidence of new-onset atrial fibrillation (AF) associated with different methods of isolated aortic valve replacement (AVR)-transfemoral (TF), transapical (TA), and transaortic (TAo) catheter-based valve replacement and conventional surgical approaches. BACKGROUND: The relative incidences of AF associated with the various access routes for AVR have not been well characterized. METHODS: In this single-center, retrospective cohort study, we evaluated a total of 231 consecutive patients who underwent AVR for degenerative aortic stenosis (AS) between March 2010 and September 2012. Patients with a history of paroxysmal, persistent, or chronic AF, with bicuspid aortic valves, and patients who died within 48 h after AVR were excluded. A total of 123 patients (53% of total group) qualified for inclusion. Data on documented episodes of new-onset AF, along with all clinical, echocardiographic, procedural, and 30-day follow-up data, were collated. RESULTS: AF occurred in 52 patients (42.3%). AF incidence varied according to the procedural method. AF occurred in 60% of patients who underwent surgical AVR (SAVR), in 53% after TA-TAVR, in 33% after TAo-TAVR cases, and 14% after TF-TAVR. The episodes occurred at a median time interval of 53 (25th to 75th percentile, 41 to 87) h after completion of the procedure. Procedures without pericardiotomy had an 82% risk reduction of AF compared with those with pericardiotomy (adjusted odds ratio: 0.18; 95% confidence interval: 0.05 to 0.59). CONCLUSIONS: AF was a common complication of AVR with a cumulative incidence of >40% in elderly patients with degenerative AS who underwent either SAVR or TAVR. AF was most common with SAVR and least common with TF-TAVR. Procedures without pericardiotomy were associated with a lower incidence of AF. CI - Copyright (c) 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved. FAU - Tanawuttiwat, Tanyanan AU - Tanawuttiwat T AD - Cardiovascular Division, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida. FAU - O'Neill, Brian P AU - O'Neill BP AD - Temple Heart and Vascular Center, Temple University, Philadelphia, Pennsylvania (formerly at Cardiovascular Division, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida). FAU - Cohen, Mauricio G AU - Cohen MG AD - Cardiovascular Division, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida. FAU - Chinthakanan, Orawee AU - Chinthakanan O AD - Department of Obstetrics and Gynecology, Chiang Mai University, Chiang Mai, Thailand. FAU - Heldman, Alan W AU - Heldman AW AD - Cardiovascular Division, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida. FAU - Martinez, Claudia A AU - Martinez CA AD - Cardiovascular Division, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida. FAU - Alfonso, Carlos E AU - Alfonso CE AD - Cardiovascular Division, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida. FAU - Mitrani, Raul D AU - Mitrani RD AD - Cardiovascular Division, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida. FAU - Macon, Conrad J AU - Macon CJ AD - Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida. FAU - Carrillo, Roger G AU - Carrillo RG AD - Cardiothoracic Surgery, Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida. FAU - Williams, Donald B AU - Williams DB AD - Cardiothoracic Surgery, Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida. FAU - O'Neill, William W AU - O'Neill WW AD - Center of Structural Heart Disease, Henry Ford Hospital and Medical Group, Detroit, Michigan. FAU - Myerburg, Robert J AU - Myerburg RJ AD - Cardiovascular Division, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida. Electronic address: rmyerbur@med.miami.edu. LA - eng PT - Clinical Trial PT - Comparative Study PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20140130 PL - United States TA - J Am Coll Cardiol JT - Journal of the American College of Cardiology JID - 8301365 SB - IM CIN - J Am Coll Cardiol. 2014 Apr 22;63(15):1520-1. PMID: 24486274 MH - Aged, 80 and over MH - Aorta, Thoracic MH - Aortic Valve Stenosis/diagnostic imaging/*surgery MH - Atrial Fibrillation/*epidemiology/etiology MH - Cardiac Catheterization/*adverse effects/methods MH - Confidence Intervals MH - Echocardiography MH - Female MH - Femoral Artery MH - Follow-Up Studies MH - Heart Valve Prosthesis Implantation/*adverse effects/methods MH - Humans MH - Incidence MH - Male MH - Odds Ratio MH - Postoperative Complications MH - Retrospective Studies MH - Risk Factors MH - Time Factors MH - Treatment Outcome MH - United States/epidemiology OTO - NOTNLM OT - atrial fibrillation OT - transcatheter aortic valve replacement EDAT- 2014/02/04 06:00 MHDA- 2014/06/11 06:00 CRDT- 2014/02/04 06:00 PHST- 2013/06/14 00:00 [received] PHST- 2013/10/10 00:00 [revised] PHST- 2013/11/19 00:00 [accepted] PHST- 2014/02/04 06:00 [entrez] PHST- 2014/02/04 06:00 [pubmed] PHST- 2014/06/11 06:00 [medline] AID - S0735-1097(14)00177-6 [pii] AID - 10.1016/j.jacc.2013.11.046 [doi] PST - ppublish SO - J Am Coll Cardiol. 2014 Apr 22;63(15):1510-9. doi: 10.1016/j.jacc.2013.11.046. Epub 2014 Jan 30.