Table 1.
Summary of sample size, method, interventions, findings, and evidence-levels of included studies.
| Study | Sample Size | Method | Intervention | Inference | Evidence-Level |
|---|---|---|---|---|---|
| Amat-Santos et al. (2012) | 138 subjects | Observation (multicenter) study | Assessment of NOAF concerning its prognostic value, outcomes, predictive factors, and incidence in the setting of TAVI | NOAF substantially increased the incidence of systemic embolism (p = 0.047) and stroke (13.6% vs. 3.2%; p = 0.021) after TAVI | II |
| Biviano et al. (2016)/PARTNER | 1,879 patients | Prospective trial (post-hoc analysis) | Clinical evaluation and assessment of echocardiogram/electrocardiogram at baseline discharge and 30-days, 6 months, and one year after TAVR | Patients who developed atrial fibrillation after sinus rhythm at discharge experienced all-cause mortality at thirty days and one-year (HR: 3.41, 95% CI 1.78, 6.54) (HR: 2.14, 95% CI 1.45, 3.10). The presence of atrial fibrillation at baseline (HR: 2.14, 95% CI 1.45, 3.10) and discharge (HR: 1.88, 95% CI 1.50, 2.36) proved to be the predictor for one-year mortality. Patients with TAVR and reduced ventricular response and atrial fibrillation at discharge showed increased one-year all-cause mortality (HR: 0.74, 95% CI 0.55, 0.99) | II |
| Chopard et al. (2015)/FRANCE-2 | 3,933 subjects | Prospective multicenter study | Assessment of prognostic value of NOAF, predictive attributes, baseline characteristics, and long-term outcomes in patients following TAVI | Patients with pre-existing atrial fibrillation experienced a higher incidence of all-cause mortality and rehospitalization as compared to patients who developed NOAF after TAVI (p < 0.001) NOAF substantially increased the incidence of post-procedural hemorrhagic events in TAVI scenarios (p < 0.001) NOAF added to the incidence rate of combined efficacy endpoint and all-cause mortality at one year in patients with TAVI (p = 0.02) |
II |
| Sannino et al. (2016) | 708 subjects | Retrospective cohort study | Assessment of prognostic outcomes of NOAF/pre-AF in patients with TAVI | patients with TAVI and pre-AF experienced a higher risk of one-year mortality (HR: 2.34, 95% CI 1.22, 4.48) (p = 0.010) | II |
| Stortecky et al. (2013) | 389 subjects | Prospective single-center trial | Assessment of the influence of atrial fibrillation on the incidence of mortality, stroke, acute kidney injury, and late bleeding episodes in patients with TAVI | patients with TAVI and atrial fibrillation experienced a greater incidence of one-year all-cause mortality as compared to patients without atrial fibrillation (HR: 2.36, 95% CI 1.43, 3.90) patients with TAVI with or without atrial fibrillation experience a high risk for life-threatening bleeding and stroke (HR: 1.37, 95% CI 0.86, 2.19) (HR: 0.76, 95% CI 0.23, 1.96) |
II |
| Tarantini et al. (2016)/SOURCE-XT | 2,688 subjects | Prospective multicenter trial | Assessment of bleeding events, cardiac death, and all-cause mortality in patients with TAVR and NOAF | NOAF elevated the incidence stroke in patients with TAVR within a tenure of 1–2 years (HR: 1.96, 95% CI 1.39, 2.76) (p = 0.0001) | II |
| Yankelson et al. (2014) | 380 subjects | Retrospective cohort study | Assessment of TAVI-related procedural complications in the context of NOAF versus pre-AF | Baseline atrial fibrillation significantly elevated mortality incidence in patients with TAVI (HR: 2.2, 95% CI 1.3, 3.8) (p = 0.003) | II |
| Nombela-Franco et al. (2012) | 1061 subjects | Retrospective cohort study | Assessment of prognostic value, predictive factors, and timing of cerebrovascular episodes in patients with TAVI | NOAF was associated with increased risk of subacute stroke (occurring 1–30 days post-TAVR) (OR: 2.76, 95 %CI 1.11, 6.83) Chronic AF in TAVR was associated with increased risk of late stroke (occurring > 30 days after TAVR) (HR: 2.84, 95% CI 1.46, 5.53) |
II |
| Mentias et al. (2019) | 72,660 subjects | Retrospective cohort study | Medicare inpatient claims data were used to assess the association of NOAF and long-term outcomes in patients with TAVR. Follow-up was 73,732 person-years. | NOAF in patients with TAVR was associated with increased risk of mortality compared with those without AF (HR: 2.07, 95% CI 1.91, 2.20) (p < 0.01) or pre-AF (HR: 1.35, 95% CI 1.26, 1.45) (p < 0.01) Compared to pre-AF, NOAF was also associated with increased risk of bleeding (HR: 1.66; 95% CI 1.48, 1.86), stroke (HR: 1.92, 95% CI 1.63, 2.26), and heart failure (HR: 1.98, 95% CI 1.81, 2.16) |
II |
| Maan et al. (2015) | 137 subjects | Retrospective cohort study | Assessment of the influence of AF on a composite of all-cause death, stroke, vascular complications, and hospitalizations within 1 month after TAVR | Pre-existing AF in patients with TAVR was associated with increased risk of death, vascular complications, and readmission within 1 month (OR: 2.60, 95% CI 1.22, 5.54) NOAF was strongly associated with the trans-apical approach in patients with TAVR (OR: 5.05, 95% CI 1.40, 18.20) |
|
| Yoon et al. (2019) | 347 subjects | Prospective cohort trial | Assessment of clinical outcomes of NOAF in patients with TAVI | Patients with TAVI and NOAF experienced a high predisposition for systemic embolism and stroke at one year (HR: 3.31, 95% CI 1.34, 8.20) | II |
| Patil et al. (2020) | 72, 666 subjects hospitalized for TAVR | Retrospective cohort study | National Inpatient Sample database was queried to assess the association between atrial fibrillation and adverse outcomes in patients receiving TAVR. | Atrial fibrillation clinically correlated with increased risk of TIA/stroke (OR: 1.36, 95% CI 1.33, 1.78), acute kidney injury (OR: 1.54, 95% CI: 1.33, 1.78), and elevated average LOS (OR: 1.30, 95% CI: 1.06, 1.54). Atrial fibrillation did not increase the risk of inpatient mortality (OR: 1.09, 95% CI 0.81, 1.48) |
II |
| Zweiker et al. (2017) | 398 subjects | Retrospective cohort study | Assessment of predictors of 1-year mortality after TAVR. Clinical records were reviewed for diagnosis of baseline atrial fibrillation and NOAF | Compared to baseline sinus rhythm, baseline atrial fibrillation was associated with higher mortality at 1 year after TAVR (19.8% vs. 11.5%, p = 0.02) NOAF was associated with increased risk of hospital readmissions (62.5 vs. 34.8%, p = 0.04) (HR: 5.86, 95% CI 1.04, 32.94), excluding mortality |
II |
| Barbash et al. (2015) | 371 subjects | Post-hoc analysis | Assessment of clinical impact, post-procedural incidence, and baseline characteristics concerning atrial fibrillation in patients with TAVI | NOAF correlated with transapical access during TAVI (OR: 4.96, 95% CI 1.9, 13.2) and procedural hemodynamic instability (OR: 9.3, 95% CI 1.5, 59) | II |
| Okuno et al. (2020) | 465 subjects | Retrospective assessment of a prospective trial | Assessment of clinical outcomes of patients with TAVR and non-valvular or valvular atrial fibrillation | Valvular atrial fibrillation substantially increased the predisposition for disabling stroke or cardiovascular death after TAVR (HR: 1.77, 95% CI 1.07, 2.94) (p = 0.027) | II |
HR = hazard ratio; CI = confidence interval; LOS = length of stay; NOAF = new-onset atrial fibrillation; OR = odds ratio; pre-AF = pre-existing atrial fibrillation; TAVI = transcatheter aortic valve implantation; TAVR = transcatheter aortic valve replacement.