Atrial fibrillation in aortic stenosis - echocardiographic assessment and prognostic importance

The purpose of this study was to assess the prognostic importance of AFib in AS.The study was designed as a single-center case-control study. Patients with AS and AFib were enrolled as cases (n？=？103) and subsequently matched to controls (103 patients with AS but sinus rhythm). Cases and controls were matched according to age, gender and severity of AS. Primary outcome was all cause mortality and follow-up was 100% complete.Compared to controls the group with AFib had lower mean ejection fraction (42% vs. 49%; p？<？0.001) and stroke volume (47 mL vs. 55 mL; p？=？0.004), but higher heart rate (81 bpm vs. 68 bpm; p？<？0.001) and no significant difference with regard to cardiac output (3.8 L vs. 4.0 L; p？=？0.29). Accordingly, aortic jet velocity and gradients were significantly lower in AFib compared to controls but there were no differences (p？=？0.38) in aortic valve area calculated by the continuity equation. During a median follow-up of 2.3 years (IQR: 1.2-3.6), 70 (34%) patients with AS died: 42 patients with AFib and 28 patients with sinus rhythm (p？<？0.02). After adjusting for echocardiographic significant differences, AFib remained an independent predictor of mortality (HR 2.72 (95% CI: 1.12–6.61), p？<？0.03). There was no significant interaction (p？=？0.62) between AFib and AS on the risk of mortality, indicating that AFib predicted bad outcome regardless of the severity of AS.AFib is an independent risk factor in patients with AS and the prognostic impact of AFib seems to be the same despite the severity of AS.Aortic stenosis (AS) and atrial fibrillation (AFib) are two conditions associated with high cardiovascular morbidity and mortality [1-5]. The incidences increase with age and as populations are ageing; both conditions are likely to become a greater public burden [1,2,6].The left ventricular (LV) response to AS is hypertrophy, impaired relaxation, increased diastolic filling pressure and left atrial dilatation [1,5,7,8]. Left atrial dilatation increases the ri