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AF patients not on anticoagulation therapy at higher risk of death after TAVR

25 Nov 2020

Individuals with atrial fibrillation (AF), diabetes, or low albumin levels are at increased risk of mortality following transcatheter aortic valve replacement (TAVR), with AF patients who are not anticoagulated being at greatest risk of dying, reveals a study.

“Efforts to identify AF and consider anticoagulation should be emphasized,” the investigators said.

Overall, 176 patients who underwent TAVR at a single centre were included in this analysis. Logistic regression was used to examine the factors associated with pacemaker implantation within 30 days, while those correlating with mortality were evaluated using Kaplan-Meier and Cox regression analyses.

Of the patients (mean age, 80±8.5 years), 69 had AF and 39 received anticoagulation. Twenty-five patients underwent a pacemaker implantation within 30 days after TAVR. Forty-nine patients succumbed to death over a follow-up of 566±496 days.

Multivariable analysis revealed that the right bundle branch block remained significant (odds ratio, 4.212; p=0.012) for pacemaker implant within 30 days. In addition, mortality was associated independently with AF (hazard ratio [HR], 3.905; p=0.001), albumin level (HR, 0.316; p=0.034), and diabetes (HR, 2.323; p=0.027), but not with pacemaker implant within 30 days.

In a stratified Kaplan-Meier analysis, AF patients who received anticoagulation therapy had better survival than those who did not receive treatment (p=0.0001).

“Patients that undergo TAVR are at risk for complete heart block requiring pacemaker implant,” the investigators said. “Additionally, other arrhythmias, specifically AF, are common in this population.”

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