Article Abstract

Impact of paroxysmal versus non-paroxysmal atrial fibrillation on outcomes in patients undergoing transcatheter mitral valve repair

Authors: Kishorbhai Gangani, Haytham Alkhaimy, Nikita Patil, Kranthi Sitammagari, Poonam Bhyan, Sameer Arora, John P. Vavalle


Background: To study the impact of type of atrial fibrillation on outcomes following transcatheter mitral valve repair. The development of atrial fibrillation (AF) in degenerative mitral regurgitation (MR) can be a sign of progression of MR and associated with adverse outcomes. However, the impact of type of AF in patients undergoing transcatheter mitral valve (MV) repair remains uncertain.
Methods: Patients 18 years or older who underwent TMVR procedure in 2016 and had a concurrent ICD-10 diagnosis of either paroxysmal or non-paroxysmal AF were included from Nationwide Readmission Database (NRD). The association between type of AF and mortality, stroke, readmission (cardiovascular and non-cardiovascular readmissions) and composite outcome (mortality, inpatient stroke or 30-day readmissions) was analyzed using multivariable logistic regression. Statistical Analysis System (SAS) software 9.4 was used to conduct the analysis.
Results: A total of 913 (weighted N=1,750) TMVR hospitalizations from NRD for year 2016 were included. Of these, 510 (weighted N=995) patients had non-paroxysmal AF and 403 (weighted N=755) had paroxysmal AF. Patients with non-paroxysmal AF were older than paroxysmal AF (83 vs. 81; P=0.0004). As compared to paroxysmal AF, those with non-paroxysmal AF had comparable odds of composite outcome of stroke, readmission, or mortality (OR 1.31; 95 % CI: 0.77–2.23), as well as stroke (OR 0.43; 95 % CI: 0.10–1.78), or mortality (OR 0.54; 95 % CI: 0.21–1.37), in patients undergoing TMVR. Similarly, no differences were noted in the odds of cardiac readmissions (OR 1.38; 95 % CI: 0.83–2.28), non-cardiac readmissions (OR 0.80; 95 % CI: 0.49–1.32) and discharge to skilled nursing/short term care (OR 1.24; 95 % CI: 0.66–2.36) in those with non-paroxysmal vs. paroxysmal AF.
Conclusions: Inpatient outcomes and readmissions were similar in patient with paroxysmal and non-paroxysmal atrial fibrillation in this study. Future studies exploring the effect of type of atrial fibrillation on long term outcomes are needed.

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