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Page 4 of 15 Tummala et al. Vessel Plus 2022;6:17 https://dx.doi.org/10.20517/2574-1209.2021.114

Table 2. Preoperative atrial fibrillation rates for transcatheter aortic valve replacement
Ref. TAVR sample size (n) Preoperative TAVR AF (%)
[7]
Jørgensen et al. 2017 40 12 (30)
[8]
Leon et al. 2016 1011 313 (31.0)
[9]
Mack et al. 2019 496 78 (15.7)
[16]
Yankelson et al. 2014 380 118 (31.1)
[17]
Maan et al. 2015 137 67 (48.9)
Sannino et al. [18] 2016 708 219 (30.9)
[19]
Zweiker et al. 2017 398 172 (43.2)
*Not specific to AS
[20]
Biviano et al. 2016 1879 504 (26.8)
[5]
Tarantini et al. 2016 1925 685 (35.6)
[15]
Mentias et al. 2019 72660 29,563 (40.7)
*Not specific to AS
[13]
Shahim et al. 2021 496 80 (16.1)
[14]
Reardon et al. 2017 864 243 (28.1)
[18]
Sannino et al. 2016 708 219 (30.9)
Comparison of preoperative TAVR AF rates. TAVR: Transcatheter aortic valve replacement; AF: atrial fibrillation; AS: aortic stenosis.
baseline AF is receiving TAVR . Beyond 30 days, preexisting AF has been an independent predictor of
[17]
major late bleeding complications, cardiovascular events, and mortality. Yankelsonet al. , studied 380
[16]
consecutive patients undergoing transcatheter aortic valve implantation, 118 of whom had baseline atrial
fibrillation, and found that baseline AF was a significant predictor of stroke and mortality. Previous AF has
been shown to be associated with an increased risk for stroke at 30 days (OR = 8.7; P = 0.058) and at 1 year
after the TAVR procedure (OR = 5.9; P = 0.015). Mortality rates at 1 year were significantly higher in
patients with previous AF at baseline than those without AF prior to TAVR (34.9% vs. 8.2%; P <0.01).
Multivariate adjusted Cox proportional hazard analysis conducted by Yankelson et al. found that previous
[16]
AF (OR = 2.2; 95%CI: 1.3-3.8) was the most significant predictor of mortality throughout the follow-up
period after the TAVR procedure. Several other studies have shown baseline AF to be significantly
associated with higher 1-year mortality or predicting 1-year mortality [5,18,19,20,25] .

NEW-ONSET POAF RISKS
SAVR
One major postprocedural complication of SAVR is new-onset POAF. A possible explanation for the
development of POAF after SAVR can be attributed to inflammation caused by surgical trauma. SAVR is
associated with several adverse surgical-related factors such as right atrium incisions for venous
cannulation, pericardiectomy, aortic cross-clamping, and cardiopulmonary bypass . This inflammation
[26]
theory is similar to the explanation of POAF development following coronary artery bypass graft surgery.
The reason why SAVR is more likely to cause POAF than TAVR can also be linked to surgical
[21]
complications .
Several risk factors have been reported in the literature to predict the development of postoperative atrial
fibrillation following SAVR and TAVR procedures. Predictive risk factors of POAF following SAVR include
a preoperative age ≥ of 70 years, low body mass index, a history of heart failure, a maximum transvalvular
gradient ≥ of 85 mmHg, end-systolic interventricular septum thickness ≥ 1.8 cm, and preoperative and early
[26]
postoperative left ventricular ejection fraction ≤ 50% . Independent predictors of prolonged POAF after
SAVR include old age and left atrial enlargement . In addition, inflammatory responses from surgical
[27]
trauma and an accompanying coronary artery bypass graft (CABG) surgery have also been shown to be