The effect of transcatheter aortic valve implantation on preexisting atrial tachyarrhythmias
Z Dadon, K Rubin, Y Michowitz, D Dvir, M Rav Acha, O Tovia-Brodie, F Bayya, M Ilan, R Jubeh, M GliksonAbstract
Background
While the hemodynamic and survival benefits of transcatheter aortic valve implantation (TAVI) for patients with severe aortic stenosis (AS) are well established, the beneficial impact of TAVI on preexisting atrial tachyarrhythmias including atrial fibrillation (AF), atrial flutter (AFL), and atrial high-rate episodes (AHRE) remains unclear.
Objectives
We aimed to evaluate the effect of TAVI on arrhythmia burden in patients with preexisting atrial tachyarrhythmias monitored by cardiac implantable electronic devices (CIEDs), and to identify predictors of arrhythmia burden reduction.
Methods
We conducted a retrospective single-center study including consecutive patients with severe AS, preexisting AF/AFL/AHRE, and a CIED capable of continuous atrial rhythm monitoring. Arrhythmia burden was assessed by device interrogation 12 months before and after the index TAVI procedure. The primary endpoint included a change in the arrhythmia burden, defined as the number, mean duration, and cumulative duration of arrhythmia episodes. Secondary endpoints included arrhythmia subtype analysis and one-year all-cause mortality.
Results
The study included 62 patients (mean age 84.5 ± 8.3 years, 46.8% female) with CIEDs and preexisting atrial tachyarrhythmias. At one year after TAVI, 12 patients (19.4%) demonstrated a reduction in arrhythmia burden, reflected by decreases in both the number and cumulative duration of the tachyarrhythmia episodes. Subgroup analysis suggested that patients with AHRE may be more likely to demonstrate burden reduction compared to those with AF or AFL. Baseline characteristics were not significantly associated with arrhythmia changes. The multivariate model showed that younger age was independently associated with a higher likelihood of post-TAVI arrhythmia burden reduction (adj_OR ≈ 0.900; 95% CI 0.820–0.980; p = 0.019), while sex was not.
Conclusions
In patients with preexisting atrial tachyarrhythmias undergoing TAVI, only a minority experienced a reduction in arrhythmia burden. Younger age was associated with a higher likelihood of post-TAVI tachyarrhythmia improvement. These findings suggest that TAVI has a limited role in rhythm control strategy, and patient-specific factors may influence the electrophysiological response. Further research is needed to clarify the mechanisms underlying these differences and to identify which patients are most likely to benefit from post-procedural arrhythmia reduction.