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Tummala et al. Vessel Plus 2022;6:17 https://dx.doi.org/10.20517/2574-1209.2021.114 Page 9 of 15

POAF has also been associated with longer length of stay after TAVR than no new AF (10.6 ± 8.1 days vs.
[25]
6.3 ± 5.0 days; P = 0.001) . Like hospital length of stay, patients with POAF are also more likely to have
longer stays in the ICU.

Other adverse outcomes like acute kidney injury (25.0% vs. 7.7%), postprocedural heart failure (44% vs.
15%), new pacemaker implantation (6.5% vs. 1.7%), myocardial infarction, and cardiac arrest have also been
significantly higher with POAF after TAVR than no AF after TAVR [20,25,52] .

Long-term
SAVR outcomes
Studies looking at the long-term impact of atrial fibrillation in patients undergoing SAVR have shown
[39]
conflicting results. Saxena et al. , found that POAF had no impact on 7-year survival in patients compared
to no new AF SAVR patients (78% vs. 83%; P = 0.63). Similarly, Swinkels et al. found that at 20 years, the
[44]
survival between patients with POAF and those without are similar. Filardo et al. , however, found that for
[45]
patients undergoing aortic valve replacement surgery, or aortic valve replacement surgery with coronary
artery bypass surgery, those who developed POAF had a 48% higher 10-year risk of mortality after
propensity matching baseline risk factors.

TAVR Outcomes
Researchers have looked at the long-term impact of POAF on a patient’s health, given the association of
POAF with serious short-term outcomes after TAVR. Like short-term outcomes, POAF has been
significantly linked to increased rates of adverse events at 1 year. Rates of rehospitalization at 1 year are
higher in patients diagnosed with POAF after their TAVR surgery than those with no new AF (62.5% vs.
[52]
34.8%; P = 0.004) . Similarly, Vora et al. found that the risk of rehospitalization due to a bleeding event
[19]
at 1 year was significantly higher in patients with POAF in comparison to those without POAF (31.7% vs.
23.0%; OR = 1.24; 95%CI: 1.10-1.40).

Similar to short-term mortality, long-term mortality has been linked to POAF after TAVR.
Amat-Santos et al. , found that the development of AF by discharge (SR/AF) was a significant predictor of
[29]
1-year mortality in patients. The mortality rate at 1 year is higher in patients with POAF after TAVR than
those with no AF development (30.1% vs. 16.1%; OR = 1.37; 95%CI: 1.19-1.59) . This increased mortality
[52]
risk at 1 year has been independently seen in several other studies [20,18,28,51,52] .

The rates of cerebrovascular events at 1 year are higher in TAVR patients who develop POAF than those
who do not (7.2% vs. 3.8%; OR = 1.50; 95%CI: 1.14-1.98) . Yoon et al. found that the development of
[47]
[52]
POAF was a predictor of the combined endpoint of stroke or embolism. This was also seen by
Amat-Santos et al. , who found that the cumulative incidence of stroke or embolism was significantly
[29]
[28]
higher in patients with POAF. Tarantini et al. , found that POAF was an independent predictor of stroke
at 2 years.
Other adverse outcomes like renal failure and new pacemaker implantation have been linked to POAF after
TAVR . A study done by Tarantini et al. found that rates of renal failure were higher amongst POAF
[28]
[20]
[51]
patients than those with sinus rhythm (32.5% vs. 14.2%, P < 0.0001). Chopard et al. found that POAF was
an independent predictor of renal failure at 1 year.