PMID- 36508765 OWN - NLM STAT- MEDLINE DCOM- 20230117 LR - 20230426 IS - 1879-1913 (Electronic) IS - 0002-9149 (Linking) VI - 189 DP - 2023 Feb 15 TI - Impact of Atrial Fibrillation on Outcomes in Very Severe Aortic Valve Stenosis. PG - 64-69 LID - S0002-9149(22)01226-7 [pii] LID - 10.1016/j.amjcard.2022.11.031 [doi] AB - The prevalence and impact of atrial fibrillation (AF) versus sinus rhythm (SR) on outcomes in very severe aortic stenosis (vsAS) of the native valve is unknown. The aim of the study was to determine the prognostic significance of AF in vsAS. A total of 563 patients with vsAS (transaortic valve peak velocity >/=5 m/s) and left ventricular ejection fraction >/=50% were identified retrospectively. Patients were divided by rhythm at the time of index transthoracic echocardiogram (AF: n = 50 [9%] vs SR: n = 513 [91%]). Patients with AF were older (83.1 +/- 7.5 vs 72.5 +/- 12.2 y, p <0.001) and had no difference in gender distribution (p = 0.49) but had a higher Charlson co-morbidity index (2 [1,3] vs 1 [0,2], p = 0.01). There was no difference in transaortic peak velocity (5.3 +/- 0.3 m/s vs 5.4 +/- 0.4 m/s, p = 0.13) and left ventricular ejection fraction was comparable (63 +/- 7 vs 66 +/- 7%, p = 0.01). Age-, gender-, Charlson co-morbidity index-, and time-dependent aortic valve replacement (AVR)-adjusted overall mortality at 5 years was significantly higher in patients with AF than patients with SR (hazard ratio [HR] 1.88 [1.23 to 2.85], p = 0.003). AVR was associated with improved survival (HR = 0.30 [0.22 to 0.42], p <0.001), with no statistically significant interaction of AVR and rhythm (p = 0.36). Outcomes were also compared in the 2 SR:1 AF propensity-matched analyses (100 SR: 50 AF), with matching done according to age, gender, clinical co-morbidities, and year of echocardiogram. In the propensity-matched analysis, age-, gender-, and time-dependent AVR-adjusted all-cause mortality was higher in AF (HR 2.32 [1.41 to 3.82], p <0.001). In conclusion, AF was not uncommon in vsAS and identified a subset of patients at a much higher risk of mortality without AVR. CI - Copyright (c) 2022 Elsevier Inc. All rights reserved. FAU - Ibrahim, Hossam AU - Ibrahim H AD - Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota. FAU - Thaden, Jeremy J AU - Thaden JJ AD - Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota. FAU - Fabre, Katarina L AU - Fabre KL AD - Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota. FAU - Scott, Christopher G AU - Scott CG AD - Department of Biostatistics, Mayo Clinic, Rochester, Minnesota. FAU - Greason, Kevin L AU - Greason KL AD - Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota. FAU - Pislaru, Sorin V AU - Pislaru SV AD - Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota. FAU - Nkomo, Vuyisile T AU - Nkomo VT AD - Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota. Electronic address: nkomo.vuyisile@mayo.edu. LA - eng PT - Journal Article DEP - 20221209 PL - United States TA - Am J Cardiol JT - The American journal of cardiology JID - 0207277 SB - IM EIN - Am J Cardiol. 2023 May 15;195:107. PMID: 37012182 MH - Humans MH - *Atrial Fibrillation/complications/epidemiology MH - Stroke Volume MH - Retrospective Studies MH - *Heart Valve Prosthesis Implantation/adverse effects MH - Treatment Outcome MH - Risk Factors MH - Ventricular Function, Left MH - *Aortic Valve Stenosis/complications/surgery MH - Aortic Valve/diagnostic imaging/surgery COIS- Disclosures The authors have no conflicts of interest to declare. EDAT- 2022/12/13 06:00 MHDA- 2023/01/18 06:00 CRDT- 2022/12/12 18:13 PHST- 2022/09/21 00:00 [received] PHST- 2022/10/28 00:00 [revised] PHST- 2022/11/17 00:00 [accepted] PHST- 2022/12/13 06:00 [pubmed] PHST- 2023/01/18 06:00 [medline] PHST- 2022/12/12 18:13 [entrez] AID - S0002-9149(22)01226-7 [pii] AID - 10.1016/j.amjcard.2022.11.031 [doi] PST - ppublish SO - Am J Cardiol. 2023 Feb 15;189:64-69. doi: 10.1016/j.amjcard.2022.11.031. Epub 2022 Dec 9.