Advertisement

Incidence and clinical impact of tachyarrhythmic events following transcatheter aortic valve replacement: A review

Published:August 08, 2022DOI:https://doi.org/10.1016/j.hrthm.2022.07.028
      Transcatheter aortic valve replacement (TAVR) is well established for treating severe symptomatic aortic stenosis. Whereas broad information on the epidemiology, clinical implications, and management of bradyarrhythmias after TAVR is available, data about tachyarrhythmic events remain scarce. Despite the progressively lower risk profile of TAVR patients and the improvement in device characteristics and operator skills, approximately 10% of patients develop new-onset atrial fibrillation (NOAF) after TAVR. The proportion of patients in whom NOAF actually corresponds to previously undiagnosed silent atrial fibrillation (AF) has not been properly determined. The transapical approach, the need for pre- or post- balloon dilation, and the presence of periprocedural complications have been associated with a higher risk of NOAF. Older age, left atrial volume, or worse functional class are patient-derived risk factors shared with preprocedural AF. NOAF after TAVR has been associated with poorer survival and a higher incidence of cerebrovascular events. However, patient management differs markedly among different centers, especially with regard to anticoagulation in patients with short-duration AF episodes detected in the periprocedural setting and in cases of silent NOAF detected during continuous electrocardiographic (ECG) monitoring. Evidence about ventricular arrhythmias is even more scarce than for AF. Some case reports of sudden cardiac death after TAVR in patients with a pacemaker have identified ventricular tachycardia or ventricular fibrillation in device interrogation. TAVR has been shown to reduce the arrhythmic burden, but a significant proportion of patients (16%) present with complex premature ventricular complex arrhythmias within the year after TAVR. Whether these events are related to poorer outcomes is unknown. Continuous ECG monitoring after TAVR may help describe the frequency, risk factors, and prognostic implications of tachyarrhythmias in this population.

      Graphical abstract

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Heart Rhythm
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Otto C.M.
        • Nishimura R.A.
        • Bonow R.O.
        • et al.
        2020 ACC/AHA Guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines.
        Circulation. 2021; 143: e35-e71
        • Vahanian A.
        • Beyersdorf F.
        • Praz F.
        • et al.
        2021 ESC/EACTS Guidelines for the management of valvular heart disease.
        Eur Heart J. 2022; 43: 561-632
        • Barbanti M.
        • Buccheri S.
        • Rodés-Cabau J.
        • et al.
        Transcatheter aortic valve replacement with new-generation devices: a systematic review and meta-analysis.
        Int J Cardiol. 2017; 245: 83-89
        • Mack M.J.
        • Leon M.B.
        • Thourani V.H.
        • et al.
        Transcatheter aortic-valve replacement with a balloon-expandable valve in low-risk patients.
        N Engl J Med. 2019; 380: 1695-1705
        • Popma J.J.
        • Deeb G.M.
        • Yakubov S.J.
        • et al.
        Transcatheter aortic-valve replacement with a self-expanding valve in low-risk patients.
        N Engl J Med. 2019; 380: 1706-1715
        • Rodés-Cabau J.
        • Ellenbogen K.A.
        • Krahn A.D.
        • et al.
        Management of conduction disturbances associated with transcatheter aortic valve replacement: JACC Scientific Expert Panel.
        J Am Coll Cardiol. 2019; 74: 1086-1106
        • Siontis G.C.M.
        • Praz F.
        • Lanz J.
        • et al.
        New-onset arrhythmias following transcatheter aortic valve implantation: a systematic review and meta-analysis.
        Heart. 2018; 104: 1208-1215
        • Papavasileiou L.P.
        • Halapas A.
        • Chrisocheris M.
        • et al.
        Sudden death after transcatheter aortic valve implantation. Are bradyarrhythmias always the cause?.
        J Atr Fibrillation. 2015; 8: 1108
        • Hindricks G.
        • Potpara T.
        • Dagres N.
        • et al.
        2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): the Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC.
        Eur Heart J. 2021; 42: 373-498
        • Yoon Y.H.
        • Ahn J.M.
        • Kang D.Y.
        • et al.
        Incidence, predictors, management, and clinical significance of new-onset atrial fibrillation after transcatheter aortic valve implantation.
        Am J Cardiol. 2019; 123: 1127-1133
        • Chopard R.
        • Teiger E.
        • Meneveau N.
        • et al.
        Baseline characteristics and prognostic implications of pre-existing and new-onset atrial fibrillation after transcatheter aortic valve implantation: results from the FRANCE-2 registry.
        JACC Cardiovasc Interv. 2015; 8: 1346-1355
        • Vora A.N.
        • Dai D.
        • Matsuoka R.
        • et al.
        Incidence, management, and associated clinical outcomes of new-onset atrial fibrillation following transcatheter aortic valve replacement: an analysis from the STS/ACC TVT registry.
        JACC Cardiovasc Interv. 2018; 11: 1746-1756
        • Smith C.R.
        • Leon M.B.
        • Mack M.J.
        • et al.
        Transcatheter versus surgical aortic-valve replacement in high-risk patients.
        N Engl J Med. 2011; 364: 2187-2198
        • Adams D.H.
        • Popma J.J.
        • Reardon M.J.
        • et al.
        Transcatheter aortic-valve replacement with a self-expanding prosthesis.
        N Engl J Med. 2014; 370: 1790-1798
        • Leon M.B.
        • Smith C.R.
        • Mack M.J.
        • et al.
        Transcatheter or surgical aortic-valve replacement in intermediate-risk patients.
        N Engl J Med. 2016; 374: 1609-1620
        • Reardon M.J.
        • Van Mieghem N.M.
        • Popma J.J.
        • et al.
        Surgical or transcatheter aortic-valve replacement in intermediate-risk patients.
        N Engl J Med. 2017; 376: 1321-1331
        • Thyregod H.G.
        • Steinbrüchel D.A.
        • Ihlemann N.
        • et al.
        Transcatheter versus surgical aortic valve replacement in patients with severe aortic valve stenosis: 1-year results from the all-comers NOTION randomized clinical trial.
        J Am Coll Cardiol. 2015; 65: 2184-2194
        • Wassef A.W.A.
        • Alnasser S.
        • Rodes-Cabau J.
        • et al.
        Institutional experience and outcomes of transcatheter aortic valve replacement: results from an international multicentre registry.
        Int J Cardiol. 2017; 245: 222-227
        • Jørgensen T.H.
        • Thyregod H.G.
        • Tarp J.B.
        • Svendsen J.H.
        • Søndergaard L.
        Temporal changes of new-onset atrial fibrillation in patients randomized to surgical or transcatheter aortic valve replacement.
        Int J Cardiol. 2017; 234: 16-21
        • Urena M.
        • Hayek S.
        • Cheema A.N.
        • et al.
        Arrhythmia burden in elderly patients with severe aortic stenosis as determined by continuous electrocardiographic recording: toward a better understanding of arrhythmic events after transcatheter aortic valve replacement.
        Circulation. 2015; 131: 469-477
        • Asmarats L.
        • Nault I.
        • Ferreira-Neto A.N.
        • et al.
        Prolonged continuous electrocardiographic monitoring prior to transcatheter aortic valve replacement: the PARE study.
        JACC Cardiovasc Interv. 2020; 13: 1763-1773
        • Winter J.L.
        • Healey J.S.
        • Sheth T.N.
        • et al.
        Remote ambulatory cardiac monitoring before and after transcatheter aortic valve replacement.
        CJC Open. 2020; 2: 416-419
        • Rodés-Cabau J.
        • Urena M.
        • Nombela-Franco L.
        • et al.
        Arrhythmic Burden as Determined by Ambulatory Continuous Cardiac Monitoring in Patients With New-Onset Persistent Left Bundle Branch Block Following Transcatheter Aortic Valve Replacement: The MARE Study..
        JACC Cardiovasc Interv. 2018; 11: 1495-1505
        • Skaf M.
        • Makki N.
        • Coressel A.
        • et al.
        Rhythm Disturbances After Transcatheter Aortic Valve Replacement: A Strategy of Surveillance.
        Cardiovasc Revasc Med. 2020; 21: 475-478
        • Auffret V.
        • Lefevre T.
        • Van Belle E.
        • et al.
        Temporal trends in transcatheter aortic valve replacement in France: FRANCE 2 to FRANCE TAVI.
        J Am Coll Cardiol. 2017; 70: 42-55
        • Ludman P.F.
        UK TAVI registry.
        Heart. 2019; 105: s2-s5
        • Carroll J.D.
        • Mack M.J.
        • Vemulapalli S.
        • et al.
        STS-ACC TVT registry of transcatheter aortic valve replacement.
        J Am Coll Cardiol. 2020; 76: 2492-2516
        • Tarantini G.
        • Mojoli M.
        • Windecker S.
        • et al.
        Prevalence and impact of atrial fibrillation in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement: an analysis from the SOURCE XT prospective multicenter registry.
        JACC Cardiovasc Interv. 2016; 9: 937-946
        • Tarantini G.
        • Mojoli M.
        • Urena M.
        • Vahanian A.
        Atrial fibrillation in patients undergoing transcatheter aortic valve implantation: epidemiology, timing, predictors, and outcome.
        Eur Heart J. 2017; 38: 1285-1293
        • Amat-Santos I.J.
        • Rodés-Cabau J.
        • Urena M.
        • et al.
        Incidence, predictive factors, and prognostic value of new-onset atrial fibrillation following transcatheter aortic valve implantation.
        J Am Coll Cardiol. 2012; 59: 178-188
        • McLeod C.J.
        • Gersh B.J.
        Atrial fibrillation post-transcatheter aortic valve replacement: cause, consequence, or confounder?.
        JACC Cardiovasc Interv. 2016; 9: 947-949
        • Barbash I.M.
        • Minha S.
        • Ben-Dor I.
        • et al.
        Predictors and clinical implications of atrial fibrillation in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation.
        Catheter Cardiovasc Interv. 2015; 85: 468-477
        • Biviano A.B.
        • Nazif T.
        • Dizon J.
        • et al.
        Atrial fibrillation is associated with increased mortality in patients undergoing transcatheter aortic valve replacement: insights from the Placement of Aortic Transcatheter Valve (PARTNER) Trial.
        Circ Cardiovasc Interv. 2016; 9e002766
        • Furuta A.
        • Lellouche N.
        • Mouillet G.
        • et al.
        Prognostic value of new onset atrial fibrillation after transcatheter aortic valve implantation: a FRANCE 2 registry substudy.
        Int J Cardiol. 2016; 210: 72-79
        • Maan A.
        • Heist E.K.
        • Passeri J.
        • et al.
        Impact of atrial fibrillation on outcomes in patients who underwent transcatheter aortic valve replacement.
        Am J Cardiol. 2015; 115: 220-226
        • Tanawuttiwat T.
        • O'Neill B.P.
        • Cohen M.G.
        • et al.
        New-onset atrial fibrillation after aortic valve replacement: comparison of transfemoral, transapical, transaortic, and surgical approaches.
        J Am Coll Cardiol. 2014; 63: 1510-1519
        • Yankelson L.
        • Steinvil A.
        • Gershovitz L.
        • et al.
        Atrial fibrillation, stroke, and mortality rates after transcatheter aortic valve implantation.
        Am J Cardiol. 2014; 114: 1861-1866
        • Kalra R.
        • Patel N.
        • Doshi R.
        • Arora G.
        • Arora P.
        Evaluation of the incidence of new-onset atrial fibrillation after aortic valve replacement.
        JAMA Intern Med. 2019; 179: 1122-1130
        • Megaly M.
        • Garcia S.
        • Anzia L.E.
        • et al.
        Detection of Atrial fibrillation and atrial flutter by pacemaker device interrogation after transcatheter aortic valve replacement (TAVR): implications for management.
        J Invasive Cardiol. 2019; 31: E177-E183
        • Sannino A.
        • Stoler R.C.
        • Lima B.
        • et al.
        Frequency of and prognostic significance of atrial fibrillation in patients undergoing transcatheter aortic valve implantation.
        Am J Cardiol. 2016; 118: 1527-1532
        • Indja B.
        • Woldendorp K.
        • Vallely M.P.
        • Grieve S.M.
        New onset atrial fibrillation following transcatheter and surgical aortic valve replacement: a systematic review and meta-analysis.
        Heart Lung Circ. 2020; 29: 1542-1553
        • Robert R.
        • Porot G.
        • Vernay C.
        • et al.
        Incidence, predictive factors, and prognostic impact of silent atrial fibrillation after transcatheter aortic valve implantation.
        Am J Cardiol. 2018; 122: 446-454
        • Fragão-Marques M.
        • Teixeira F.
        • Mancio J.
        • et al.
        Impact of oral anticoagulation therapy on postoperative atrial fibrillation outcomes: a systematic review and meta-analysis.
        Thromb J. 2021; 19: 89
        • Dangas G.D.
        • Tijssen J.G.P.
        • Wöhrle J.
        • et al.
        A controlled trial of rivaroxaban after transcatheter aortic-valve replacement.
        N Engl J Med. 2020; 382: 120-129
        • Healey J.S.
        • Connolly S.J.
        • Gold M.R.
        • et al.
        Subclinical atrial fibrillation and the risk of stroke.
        N Engl J Med. 2012; 366: 120-129
        • Lopes R.D.
        • Alings M.
        • Connolly S.J.
        • et al.
        Rationale and design of the Apixaban for the Reduction of Thrombo-Embolism in Patients With Device-Detected Sub-Clinical Atrial Fibrillation (ARTESiA) trial.
        Am Heart J. 2017; 189: 137-145
        • Kirchhof P.
        • Blank B.F.
        • Calvert M.
        • et al.
        Probing oral anticoagulation in patients with atrial high rate episodes: rationale and design of the Non-vitamin K antagonist Oral anticoagulants in patients with Atrial High rate episodes (NOAH-AFNET 6) trial.
        Am Heart J. 2017; 190: 12-18
        • Perez M.V.
        • Mahaffey K.W.
        • Hedlin H.
        • et al.
        Large-scale assessment of a smartwatch to identify atrial fibrillation.
        N Engl J Med. 2019; 381: 1909-1917
        • Tay E.L.
        • Gurvitch R.
        • Wijesinghe N.
        • et al.
        A high-risk period for cerebrovascular events exists after transcatheter aortic valve implantation.
        JACC Cardiovasc Interv. 2011; 4: 1290-1297
        • Tempio D.
        • Pruiti G.P.
        • Conti S.
        • et al.
        Ventricular arrhythmias in aortic valve stenosis before and after transcatheter aortic valve implantation.
        Europace. 2015; 17: 1136-1140
        • Beinart R.
        • Danik S.
        • Palacios I.
        • et al.
        Ventricular tachycardia following trans-apical aortic valve replacement.
        Europace. 2012; 14: 450-452
        • Dvir D.
        • Haim M.
        • Kornowski R.
        Left-ventricular outflow tract ventricular-tachycardia event following CoreValve transcatheter aortic-valve implantation.
        Catheter Cardiovasc Interv. 2012; 79: 331-333
        • Eckart R.E.
        • Hruczkowski T.W.
        • Tedrow U.B.
        • Koplan B.A.
        • Epstein L.M.
        • Stevenson W.G.
        Sustained ventricular tachycardia associated with corrective valve surgery.
        Circulation. 2007; 116: 2005-2011
        • Nombela-Franco L.
        • del Trigo M.
        • Morrison-Polo G.
        • et al.
        Incidence, causes, and predictors of early (≤30 days) and late unplanned hospital readmissions after transcatheter aortic valve replacement.
        JACC Cardiovasc Interv. 2015; 8: 1748-1757
        • Ullah W.
        • Zahid S.
        • Hamzeh I.
        • Birnbaum Y.
        • Virani S.S.
        • Alam M.
        Trends and predictors of transcatheter aortic valve implantation related in-hospital mortality (from the National Inpatient Sample Database).
        Am J Cardiol. 2021; 143: 97-103
        • Lown B.
        • Wolf M.
        Approaches to sudden death from coronary heart disease.
        Circulation. 1971; 44: 130-142
        • Pellikka P.A.
        • Sarano M.E.
        • Nishimura R.A.
        • et al.
        Outcome of 622 adults with asymptomatic, hemodynamically significant aortic stenosis during prolonged follow-up.
        Circulation. 2005; 111: 3290-3295
        • Rosenhek R.
        • Klaar U.
        • Schemper M.
        • et al.
        Mild and moderate aortic stenosis. Natural history and risk stratification by echocardiography.
        Eur Heart J. 2004; 25: 199-205
        • Bastiaenen R.
        • Batchvarov V.
        • Gallagher M.M.
        Ventricular automaticity as a predictor of sudden death in ischaemic heart disease.
        Europace. 2012; 14: 795-803
        • Stecker E.C.
        • Nazer B.
        • Dewland T.A.
        Primary prevention ICDs in nonischemic cardiomyopathy: time to put the toothpaste back in the tube?.
        J Am Coll Cardiol. 2020; 76: 416-418
        • Køber L.
        • Thune J.J.
        • Nielsen J.C.
        • et al.
        Defibrillator implantation in patients with nonischemic systolic heart failure.
        N Engl J Med. 2016; 375: 1221-1230
        • Kang D.H.
        • Park S.J.
        • Lee S.A.
        • et al.
        Early surgery or conservative care for asymptomatic aortic stenosis.
        N Engl J Med. 2020; 382: 111-119
        • Banovic M.
        • Putnik S.
        • Penicka M.
        • et al.
        Aortic Valve ReplAcemenT versus Conservative Treatment in Asymptomatic SeveRe Aortic Stenosis: the AVATAR trial.
        Circulation. 2022; 145: 648-658
        • Maganti K.
        • Rigolin V.H.
        • Sarano M.E.
        • Bonow R.O.
        Valvular heart disease: diagnosis and management.
        Mayo Clin Proc. 2010; 85: 483-500
        • Puls M.
        • Beuthner B.E.
        • Topci R.
        • et al.
        Impact of myocardial fibrosis on left ventricular remodelling, recovery, and outcome after transcatheter aortic valve implantation in different haemodynamic subtypes of severe aortic stenosis.
        Eur Heart J. 2020; 41: 1903-1914
        • Musa T.A.
        • Treibel T.A.
        • Vassiliou V.S.
        • et al.
        Myocardial scar and mortality in severe aortic stenosis.
        Circulation. 2018; 138: 1935-1947
        • Lota A.S.
        • Tsao A.
        • Owen R.
        • et al.
        Prognostic significance of nonischemic myocardial fibrosis in patients with normal LV volumes and ejection-fraction.
        JACC Cardiovasc Imaging. 2021; 14: 2353-2365
        • Muntané-Carol G.
        • Philippon F.
        • Nault I.
        • et al.
        Ambulatory electrocardiogram monitoring in patients undergoing transcatheter aortic valve replacement: JACC state-of-the-art review.
        J Am Coll Cardiol. 2021; 77: 1344-1356