Postoperative Atrial Fibrillation or Flutter Following Transcatheter or Surgical Aortic Valve Replacement: PARTNER 3 Trial.

Objectives: The aim of this study was to assess the incidence and prognostic impact of early and late postoperative atrial fibrillation or flutter (POAF) in patients with severe aortic stenosis (AS) treated with transcatheter aortic valve replacement (TAVR) or surgical aortic valve replacement (SAVR).
Background: There is an ongoing controversy regarding the incidence, recurrence rate, and prognostic impact of early (in-hospital) POAF and late (postdischarge) POAF in patients with AS undergoing TAVR or SAVR.
Methods: In the PARTNER (Placement of Aortic Transcatheter Valve) 3 trial, patients with severe AS at low surgical risk were randomized to TAVR or SAVR. Analyses were performed in the as-treated population excluding patients with preexistent atrial fibrillation or flutter.
Results: Among 781 patients included in the analysis, early POAF occurred in 152 (19.5%) (18 of 415 [4.3%] and 134 of 366 [36.6%] following TAVR and SAVR, respectively). Following discharge, 58 new or recurrent late POAF events occurred within 1 year following the index procedure in 55 of 781 patients (7.0%). Early POAF was not an independent predictor of late POAF following discharge (odds ratio: 1.04; 95% CI: 0.52-2.08; P = 0.90). Following adjustment, early POAF was not an independent predictor of the composite outcome of death, stroke, or rehospitalization (hazard ratio: 1.10; 95% CI: 0.64-1.92; P = 0.72), whereas late POAF was associated with an increased adjusted risk for the composite outcome (hazard ratio: 8.90; 95% CI: 5.02-15.74; P < 0.0001), irrespective of treatment modality.
Conclusions: In the PARTNER 3 trial, early POAF was more frequent following SAVR compared with TAVR. Late POAF, but not early POAF, was significantly associated with worse outcomes at 2 years, irrespective of treatment modality.
Competing Interests: Funding Support and Author Disclosures The PARTNER 3 trial was funded by Edwards Lifesciences. Dr Malaisrie is a consultant for Edwards Lifesciences, Medtronic, and Abbott. Dr George is a consultant for Edwards Lifesciences. Dr Thourani does research and is a consultant for Abbott Vascular, Allergen, Boston Scientific, CryoLife, Edwards Lifesciences, Gore Vascular, and JenaValve. Dr Babaliaros has received institutional research funding from Abbott, Edwards Lifesciences, and Medtronic; has received consulting fees from Edwards Lifesciences; and holds equity in Transmural Systems. Dr Kodali has received institutional research grants from Edwards Lifesciences, Medtronic, and Abbott; has received consulting fees from Abbott, Admedus, and Meril Life; and holds equity options from Biotrace Medical and Thubrikar Aortic Valve. Dr Nazif is a consultant for Edwards Lifesciences, Medtronic, and Boston Scientific. Dr Genereux has received consulting fees from Abbott Vascular, Abiomed, Boston Scientific, Cardinal Health, Cardiovascular Systems, Edwards Lifesciences, Medtronic, Opsens, Siemens, SoundBite Medical Solutions, Sig.Num, Saranas, Teleflex, and Tryton Medical; and has equity in Pi-Cardia, Sig.Num, SoundBite Medical Solutions, Saranas, and Puzzle Medical. Drs Lu and Yu are employees of Edwards Lifesciences. Ms Alu has received institutional research support (no direct compensation) from Abbott and Edwards Lifesciences. Dr Webb is a proctor and consultant for Edwards Lifesciences. Dr Mack has received institutional research support (no direct physician compensation) from Edwards Lifesciences. Dr Leon has received institutional research support from Edwards Lifesciences, Medtronic, Boston Scientific, and Abbott; and is a consultant or advisory board member for Medtronic, Boston Scientific, Gore, Meril Life, and Abbott. Dr Kosmidou has received institutional research support from Amgen; and is a consultant for Sanofi. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
(Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.)