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Original research article
New-onset arrhythmias following transcatheter aortic valve implantation: a systematic review and meta-analysis
  1. George C M Siontis,
  2. Fabien Praz,
  3. Jonas Lanz,
  4. René Vollenbroich,
  5. Laurent Roten,
  6. Stefan Stortecky,
  7. Lorenz Räber,
  8. Stephan Windecker,
  9. Thomas Pilgrim
  1. Department of Cardiology, Swiss Cardiovascular Center Bern, University of Bern, Bern, Switzerland
  1. Correspondence to Dr Thomas Pilgrim, Department of Cardiology, Swiss Cardiovascular Center Bern, University of Bern, Bern ,Switzerland ; Thomas.pilgrim{at}insel.ch

Abstract

Objective To evaluate the prevalence and clinical impact of new-onset arrhythmias in patients following transcatheter aortic valve implantation (TAVI).

Method We systematically identified studies reporting new-onset arrhythmias after TAVI other than atrioventricular conduction disturbances. We summarised monitoring strategies, type and prevalence of arrhythmias and estimated their effect on risk of death or cerebrovascular events by using random-effects meta-analysis. The study is registered withInternational prospective register of systematic reviews (PROSPERO) (CRD42017058053).

Results Sixty-five studies (43 506 patients) reported new-onset arrhythmias following TAVI. The method of arrhythmia detection was specified only in 31 studies (48%). New-onset atrial fibrillation (NOAF) (2641 patients), bradyarrhythmias (182 patients), supraventricular arrhythmias (29 patients), ventricular arrhythmias (28 patients) and non-specified major arrhythmias (855 patients) were reported. In most studies (52 out of 65), new-onset arrhythmia detection was limited to the first month following TAVI. The most frequently documented arrhythmia was NOAF with trend of increasing summary prevalence of 11%, 14%, 14% and 25% during inhospital, 30-day, 1-year and 2-year follow-ups, respectively (P for trend=0.011). Summary prevalence estimates of NOAF at 30-day follow-up differ significantly between studies of prospective and retrospective design (8% and 21%, respectively, P=0.002). New episodes of bradyarrhythmias were documented with a summary crude prevalence of 4% at 1-year follow-up. NOAF increased the risk of death (relative risk 1.61, 95% CI 1.35 to 1.98, I2=47%) and cerebrovascular events (1.79, 95% CI 1.24 to 2.64, I2=0%). No study commented on therapeutic modifications following the detection of new-onset arrhythmias.

Conclusions Systematic identification of new-onset arrhythmias following TAVI may have considerable impact on subsequent therapeutic management and long-term prognosis in this patient population.

  • transcatheter valve interventions
  • aortic stenosis
  • meta-analysis
  • atrial fibrillation
  • bradyarrhythmias

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Footnotes

  • Contributors GCMS, SW and TP designed the study. GCMS, FP, JL, RV, LR and SS identified and acquired reports of relevant trials. GCMS, FP, JL, RV, LaR, SS and LoR extracted data. GCMS and TP analysed data. GCMS, SW and TP interpreted the data. GCMS and TP drafted the manuscript. FP, JL, RV, LaR, SS, LoR and SW critically reviewed the document. All authors approved the final submitted version.

  • Competing interests FP is a consultant for Edwards Lifesciences. SW has received research grants to the institution from Bracco, Boston Scientific and Terumo, outside the submitted work. TP received research grants to the institution from Edwards Lifesciences, Symetis and Biotronik.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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