Atrial Fibrillation and Outcomes After Transcatheter or Surgical Aortic Valve Replacement (From the PARTNER 3 Trial).

The prognostic impact of preexisting atrial fibrillation or flutter (AF) in low-risk patients with severe aortic stenosis (AS) treated with transcatheter (TAVR) or surgical aortic valve replacement (SAVR) remains unknown. In this sub-analysis of the PARTNER 3 trial of patients with severe aortic stenosis at low surgical risk randomized 1:1 to TAVR versus SAVR, clinical outcomes were analyzed at 2 years according to AF status. Among 948 patients included in the analysis [452 (47.7%) in the SAVR vs 496 (52.3%) in the TAVR arm], 168 (17.6%) patients had AF [88/452 (19.5%) and 80/496 (16.1%) treated with SAVR and TAVR, respectively]. At 2 years, patients with AF had higher unadjusted rates of the composite outcome of death, stroke or rehospitalization (21.2% vs 12.9%, p=0.007) and rehospitalization alone (15.3% vs 9.4%, p=0.03) but not all-cause death (3.8 vs 2.6%, p=0.45) or stroke (4.8% vs 2.6%, p=0.12). In adjusted analyses, patients with AF had a higher risk for the composite outcome of death, stroke or rehospitalization (hazard ratio [HR] 1.80, 95% confidence interval [CI] 1.20-2.71, p=0.0046) and rehospitalization alone (HR 1.8, 95% CI 0.12-2.9, p=0.015), but not death or stroke. There was no interaction between treatment modality and AF on the composite outcome (Pinter=0.83). In conclusion, preexisting AF in patients with severe AS at low surgical risk was associated with increased risk of the composite outcome of death, stroke or rehospitalization at 2 years, irrespective of treatment modality.