Prolonged atrial refractoriness to predict the onset of atrial fibrillation after transcatheter aortic valve implantation.

Background: Atrial fibrillation (AF) is the most common atrial arrhythmia after transcatheter aortic valve implantation (TAVI) and is associated with high mortality. Although some clinical and echocardiographic variables have been defined to predict new-onset atrial fibrillation (NOAF), electrophysiologic (EP) parameters have not been identified yet. We aimed to investigate the impact of atrial refractoriness on NOAF after TAVI.

Methods: Seventy-nine consecutive patients who underwent TAVI were enrolled in this trial. All patients undergoing TAVI were screened for AF.

Results: Fifteen (19%) had AF during the follow-up period. Patients with NOAF were older and had a higher BMI and STS. Left atrial diameter (LAD) was higher, left ventricular ejection fraction (LVEF) was lower, and preprocedural LVEDP was higher in patients with NOAF. As electrophysiologic (EP) parameters, atrial effective refractory periods (AERP) (in high right atrium [AERPHRA], in right posterolateral atrium [AERPRPL], and in distal coronary sinus [AERPDCS]) were lower, difference between atrial effective refractory periods (AERPDISP) and PA intervals were higher in patients with AF than those without AF. The only independent parameter that influenced the development of AF after TAVI was AERPDISP. The Receiver Operating Characteristic (ROC) analysis showed that an AERPDISP>46 msec significantly separated those with AF and those without AF with a sensitivity of 85% and a specificity of 97%.

Conclusions: The current study demonstrates that the only independent variable predicting NOAF is AERPDISP. Therefore, increased AERPDISP values may help predict patients with high risk for NOAF and needing specific therapies.