Impact of atrial fibrillation on outcomes of patients treated by transcatheter aortic valve implantation: A systematic review and meta-analysis

Background Conflicting data have been reported related to the impact of atrial fibrillation (AF) on the outcomes after transcatheter aortic valve implantation (TAVI). We aimed to assess the prognosis of TAVI-treated patients according to the presence of pre-existing or new-onset AF. Methods Studies published between April 2002 and November 2016 and reporting outcomes of pre-existing AF, new-onset AF, or sinus rhythmin patients undergoing TAVI were identified with an electronic search. Pairwise and network meta-analysis were performed. Outcomes of interest were short-and long-term mortality, stroke, and major bleeding. Results Eleven studies (11,033 individuals) were eligible. Compared to sinus rhythm, short-term and long-term mortality were significantly higher in new-onset AF (short-term OR 2.9, P =.002; long-term OR 2.3, P < .0001) and pre-existing AF groups (short-termOR 2.7, P =.004; long-term OR 2.8, P < .0001). Compared to sinus rhythm, new-onset AF increased the risk of stroke at early (OR 2.1, P <.0001) and late follow-up (OR 1.92, P =.0001), and the risk of early bleedings (OR 1.65, P =.002), while preexisting AF increased the risk of late stroke (OR 1.3, P < 0.03), but not the risk of bleeding. Compared to pre-existing AF, new-onset AF correlated with higher risk of early stroke (OR 1.7, P =.002) and major bleedings (OR 1.7, P =.002). Conclusions AF is associated with impaired outcomes after TAVI, including mortality, stroke and (limited to new-onset AF) major bleedings. Compared to pre-existing AF, new-onset AF correlates with higher risk of early stroke and major bleedings. Improved management of AF in the TAVI setting, including tailored antithrombotic treatment strategies, remains a relevant need.