PMID- 33754803 OWN - NLM STAT- MEDLINE DCOM- 20211021 LR - 20211021 IS - 2047-9980 (Electronic) IS - 2047-9980 (Linking) VI - 10 IP - 7 DP - 2021 Apr 6 TI - Atrial Fibrillation Is Associated With Mortality in Intermediate Surgical Risk Patients With Severe Aortic Stenosis: Analyses From the PARTNER 2A and PARTNER S3i Trials. PG - e019584 LID - 10.1161/JAHA.120.019584 [doi] LID - e019584 AB - Background The impact of atrial fibrillation (AF) in intermediate surgical risk patients with severe aortic stenosis who undergo either transcatheter or surgical aortic valve replacement (AVR) is not well established. Methods and Results Data were assessed in 2663 patients from the PARTNER (Placement of Aortic Transcatheter Valve) 2A or S3i trials. Analyses grouped patients into 3 categories according to their baseline and discharge rhythms (ie, sinus rhythm [SR]/SR, SR/AF, or AF/AF). Among patients with transcatheter AVR (n=1867), 79.2% had SR/SR, 17.6% had AF/AF, and 3.2% had SR/AF. Among patients with surgical AVR (n=796), 71.7% had SR/SR, 14.1% had AF/AF, and 14.2% had SR/AF. Patients with transcatheter AVR in AF at discharge had increased 2-year mortality (SR/AF versus SR/SR; hazard ratio [HR], 2.73; 95% CI, 1.68-4.44; P<0.0001; AF/AF versus SR/SR; HR, 1.56; 95% CI, 1.16-2.09; P=0.003); patients with SR/AF also experienced increased 2-year mortality relative to patients with AF/AF (HR, 1.77; 95% CI, 1.04-3.00; P=0.03). For patients with surgicalAVR, the presence of AF at discharge was also associated with increased 2-year mortality (SR/AF versus SR/SR; HR, 1.93; 95% CI, 1.25-2.96; P=0.002; and AF/AF versus SR/SR; HR, 1.67; 95% CI, 1.06-2.63; P=0.027). Rehospitalization and persistent advanced heart failure symptoms were also more common among patients with transcatheter AVR and surgical AVR discharged in AF, and major bleeding was more common in the transcatheter AVR cohort. Conclusions The presence of AF at discharge in patients with intermediate surgical risk aortic stenosis was associated with worse outcomes-especially in patients with baseline SR-including increased all-cause mortality at 2-year follow-up. Registration URL: https://www.clinicaltrials.gov; Unique identifiers: NCT01314313 and NCT03222128. FAU - Brener, Michael I AU - Brener MI AD - Division of Cardiology NewYork Presbyterian-Columbia University Medical Center New York NY. FAU - George, Isaac AU - George I AD - Division of Cardiology NewYork Presbyterian-Columbia University Medical Center New York NY. FAU - Kosmidou, Ioanna AU - Kosmidou I AD - Division of Cardiology NewYork Presbyterian-Columbia University Medical Center New York NY. AD - Cardiovascular Research Foundation New York NY. FAU - Nazif, Tamim AU - Nazif T AD - Division of Cardiology NewYork Presbyterian-Columbia University Medical Center New York NY. FAU - Zhang, Zixuan AU - Zhang Z AD - Cardiovascular Research Foundation New York NY. FAU - Dizon, Jose M AU - Dizon JM AD - Division of Cardiology NewYork Presbyterian-Columbia University Medical Center New York NY. FAU - Garan, Hasan AU - Garan H AD - Division of Cardiology NewYork Presbyterian-Columbia University Medical Center New York NY. FAU - Malaisrie, S Chris AU - Malaisrie SC AD - Northwestern University Feinberg School of Medicine Chicago IL. FAU - Makkar, Raj AU - Makkar R AD - Cedars-Sinai Medical Center Los Angeles CA. FAU - Mack, Michael AU - Mack M AD - Baylor Scott & White Health Plano TX. FAU - Szeto, Wilson Y AU - Szeto WY AD - University of Pennsylvania Philadelphia PA. FAU - Fearon, William F AU - Fearon WF AD - Stanford University Stanford CA. FAU - Thourani, Vinod H AU - Thourani VH AD - Piedmont Heart & Vascular Institute Atlanta GA. FAU - Leon, Martin B AU - Leon MB AD - Division of Cardiology NewYork Presbyterian-Columbia University Medical Center New York NY. AD - Cardiovascular Research Foundation New York NY. FAU - Kodali, Susheel AU - Kodali S AD - Division of Cardiology NewYork Presbyterian-Columbia University Medical Center New York NY. FAU - Biviano, Angelo B AU - Biviano AB AD - Division of Cardiology NewYork Presbyterian-Columbia University Medical Center New York NY. LA - eng SI - ClinicalTrials.gov/NCT03222128 SI - ClinicalTrials.gov/NCT01314313 PT - Journal Article PT - Multicenter Study PT - Randomized Controlled Trial DEP - 20210323 PL - England TA - J Am Heart Assoc JT - Journal of the American Heart Association JID - 101580524 SB - IM MH - Aged, 80 and over MH - Aortic Valve Stenosis/complications/*surgery MH - Atrial Fibrillation/*complications/physiopathology MH - Electrocardiography MH - Female MH - Heart Rate/*physiology MH - Humans MH - Incidence MH - Male MH - Postoperative Complications/*epidemiology MH - Survival Rate/trends MH - Transcatheter Aortic Valve Replacement/*methods MH - Treatment Outcome MH - United States/epidemiology PMC - PMC8174321 OTO - NOTNLM OT - aortic stenosis OT - atrial fibrillation OT - transcatheter aortic valve replacement COIS- George is a consultant for MitreMedical, CardioMech, WL Gore, Atricure, Neptune Medical. Nazif is a consultant for Edwards Lifesciences, Medtronic, Boston Scientific. Malaisrie is a consultant for Edwards Lifesciences, Medtronic, Abbott. Makkar reports research grants from Edwards Life Sciences, Abbott, Medtronic and Boston Scientific; personal proctoring fee from Edwards Life Sciences; and travel support from Edwards, Abbott and Boston Scientific. Mack reports institutional research support (no direct financial compensation) from Edwards Lifesciences. Thourani reports research funding and consulting for Abbott, Allergen, Boston Scientific, Cryolife, Edwards Lifescience, Gore, Jenavalve. Leon reports institutional research support (no direct financial compensation) from Edwards Lifesciences, Medtronic, Boston Scientific, Abbott. Consultant/Advisory Board for Medtronic, Boston Scientific, Gore, Meril Lifesciences, and Abbott. Kodali reports institutional research support (no direct financial compensation) from Edwards Lifesciences, Medtronic, Abbott. Consultant for Abbott, Admedus, Meril Lifesciences. Equity options from Biotrace Medical and Thubrikar Aortic Valve, Inc. Biviano is on the Medical Advisory Board for Biosense Webster and Boston Scientific. The remaining authors have no disclosures to report. EDAT- 2021/03/24 06:00 MHDA- 2023/02/25 06:00 PMCR- 2021/04/06 CRDT- 2021/03/23 12:18 PHST- 2021/03/24 06:00 [pubmed] PHST- 2023/02/25 06:00 [medline] PHST- 2021/03/23 12:18 [entrez] PHST- 2021/04/06 00:00 [pmc-release] AID - JAH36120 [pii] AID - 10.1161/JAHA.120.019584 [doi] PST - ppublish SO - J Am Heart Assoc. 2021 Apr 6;10(7):e019584. doi: 10.1161/JAHA.120.019584. Epub 2021 Mar 23.