Background: Atrial fibrillation (AF) in severe aortic stenosis (AS) has poor outcomes after transcatheter and surgical aortic valve replacement (TAVR and SAVR, respectively). We compared the incidence of AF after aortic valve replacement (AVR) according to the treatment method and the impact of AF on outcomes.

Methods: We investigated the incidence of AF and clinical outcomes of AVR according to whether AF occurred after TAVR and SAVR after propensity score (PS)-matching for 1 year follow-up. Clinical outcomes were defined as death, stroke, and admission due to heart failure. The composite outcome comprised death, stroke, and admission due to heart failure.

Results: A total of 221 patients with severe AS were enrolled consecutively, 100 of whom underwent TAVR and 121 underwent SAVR. The incidence of newly detected AF was significantly higher in the SAVR group before PS-matching (6.0 vs. 40.5%, P < 0.001) and after PS-matching (7.5 vs. 35.6%, P = 0.001). TAVR and SAVR showed no significant differences in outcomes except in terms of stroke. In the TAVR group, AF history did not affect the outcomes; however, in the SAVR group, AF history affected death (log rank P = 0.038). Post-AVR AF had a worse impact on admission due to heart failure (log rank P = 0.049) and composite outcomes in the SAVR group. Post-AVR AF had a worse impact on admission due to heart failure (log rank P = 0.008) and composite outcome in the TAVR group.

Conclusion: Post-AVR AF could be considered as a predictor of the outcomes of AVR. TAVR might be a favorable treatment option for patients with severe symptomatic AS who are at high-risk for AF development or who have a history of AF because the occurrence of AF was more frequent in the SAVR group.

背景：经导管和外科主动脉瓣置换术（分别为 TAVR 和 SAVR）后，严重主动脉瓣狭窄 (AS) 中的房颤 (AF) 预后不佳。我们根据治疗方法比较了主动脉瓣置换术 (AVR) 后 AF 的发生率以及 AF 对结果的影响。

方法：我们根据倾向评分 (PS) 匹配后 1 年随访后 TAVR 和 SAVR 后是否发生 AF 来调查 AF 的发生率和 AVR 的临床结果。临床结果被定义为死亡、中风和因心力衰竭而入院。复合结局包括死亡、中风和因心力衰竭入院。

结果：共连续招募了 221 名重度 AS 患者，其中 100 名接受了 TAVR，121 名接受了 SAVR。PS匹配前SAVR组新检出AF的发生率显着更高（6.0% vs. 40.5%，磷 < 0.001) 和 PS 匹配后（7.5 对 35.6%， 磷= 0.001）。除卒中外，TAVR 和 SAVR 在结局方面没有显着差异。在 TAVR 组中，房颤病史不影响结果；然而，在 SAVR 组中，房颤病史影响了死亡（log rank磷= 0.038）。AVR 后 AF 对因心力衰竭入院的影响更差（对数等级磷= 0.049) 和 SAVR 组的综合结果。AVR 后 AF 对因心力衰竭入院的影响更差（对数等级磷 = 0.008) 和 TAVR 组的复合结果。

结论：AVR 后 AF 可被视为 AVR 结局的预测指标。TAVR 可能是房颤发生高风险或有房颤病史的重度症状性 AS 患者的有利治疗选择，因为 SAVR 组房颤发生率更高。