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Tummala et al. Vessel Plus 2022;6:17 https://dx.doi.org/10.20517/2574-1209.2021.114 Page 3 of 15

Table 1. Preoperative atrial fibrillation rates for surgical aortic valve replacement
Ref. SAVR sample size (n) Preoperative SAVR AF (%)
[7]
Jørgensen et al. 2017 38 8 (21.1)
[8]
Leon et al. 2016 1021 359 (35.2)
[9]
Mack et al. 2019 454 85 (18.8)
[10]
Smith et al. 2011 351 30 days: 56 (16.0)
1 year: 60 (17.1)
Takahashi et al. [11] 2014 63 4 (6.3)
[12]
Bowdish et al. 2016 492 53 (10.8)
*Not specific to AS
[13]
Shahim et al. 2021 452 88 (19.5)
Reardon et al. [14] 2017 796 211 (26.5)
Comparison of preoperative SAVR AF rates. SAVR: Surgical aortic valve replacement; AF: atrial fibrillation; AS: aortic stenosis.

TAVR
Pre-existing atrial fibrillation has been reported in 15.7%-48.9% of patients undergoing TAVR [Table 2].
Furthermore, Tarantini et al. reported that pre-existing atrial fibrillation has a significantly higher
[5]
prevalence in TAVR patients treated using the transapical approach than those treated using the
transfemoral approach (41.8% vs. 32.7%, P < 0.01). The higher rates of preoperative atrial fibrillation in
TAVR compared to SAVR can be attributed to more comorbidities and a worse clinical profile among
TAVR patients .
[21]

Cardiac diseases
While atrial fibrillation in patients undergoing aortic valve replacement is fairly common, it is essential to
know the prevalence of atrial fibrillation in aortic stenosis and compare this prevalence with the prevalence
of atrial fibrillation in other similar conditions, such as aortic regurgitation, mitral stenosis, and coronary
artery disease (CAD), above the normal increase due to aging. Pre-existing atrial fibrillation is seen in 5.0%
of aortic stenosis patients and a similar 5.8% in aortic regurgitation . Pre-existing atrial fibrillation has
[22]
been seen in 33.9% of patients with mitral valve stenosis, significantly higher than the prevalence rates seen
in aortic stenosis . While the prevalence of CAD in atrial fibrillation patients is quite high, the rate of atrial
[22]
fibrillation in CAD patients is only around 0.2% to 5% . These low rates are also seen in normal aging, with
[23]
a prevalence of atrial fibrillation of 2.3% among people over 40 years and 5.9% among people over 65
[24]
years .

PREOP AF OUTCOMES
SAVR
A significant proportion of patients receiving aortic valve replacement have pre-existing atrial fibrillation.
Shahim et al. studied the impact of pre-existing atrial fibrillation on outcomes after aortic valve
[13]
replacement surgery. They found that atrial fibrillation was significantly associated with non-cardiac-related
death and major complications. Death, stroke, or rehospitalization at 2 years occurred in 24.6% of SAVR
patients with preexisting atrial fibrillation but only occurred in 15.8% of SAVR patients without
preoperative AF (OR = 2.22; 95%CI: 1.19-4.13). Further studies are needed to truly understand the impact of
pre-existing atrial fibrillation in the SAVR specific population.

TAVR
Given the prevalence of preoperative atrial fibrillation, several studies have tried to determine the impact of
baseline atrial fibrillation on post-TAVR outcomes. Short-term 30-day, adverse outcomes like mortality,
stroke, vascular complications, and repeat hospitalization have been significantly higher in patients with