title: Excellent outcomes for transcatheter aortic valve replacement within 1 year of opening a low-volume centre and consideration of requirements. Acute and long-term (2-years) clinical outcomes of the CoreValve 31mm in large aortic annuli: A multicenter study. Incidence, predictive factors, and prognostic value of new-onset atrial fibrillation following transcatheter aortic valve implantation. Mid-term study of transcatheter aortic valve implantation in an Asian population with severe aortic stenosis: two-year Valve Academic Research Consortium-2 outcomes. In-office insertion of a miniaturized insertable cardiac monitor: Results from the Reveal LINQ In-Office 2 randomized study. Acute and 30-Day Outcomes in Women After TAVR: Results From the WIN-TAVI (Women's INternational Transcatheter Aortic Valve Implantation) Real-World Registry. Atrial Fibrillation and Aortic Stenosis: Impact on Clinical Outcomes Among Patients Undergoing Transcatheter Aortic Valve Implantation 1-Year Outcomes With the Fully Repositionable and Retrievable Lotus Transcatheter Aortic Replacement Valve in 120 High-Risk Surgical Patients With Severe Aortic Stenosis: Results of the REPRISE II Study. Transcatheter versus Surgical Aortic Valve Replacement in High-risk Patients: A propensity-score matched analysis. Analysis of long-term survival following transcatheter aortic valve implantation from a single high-volume center. Long-term Follow-up After Transcatheter Aortic Valve Implantation for Severe Aortic Stenosis. Transcatheter aortic-valve replacement with a self-expanding prosthesis. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions Coronary Artery Disease and Symptomatic Severe Aortic Valve Stenosis: Clinical Outcomes after Transcatheter Aortic Valve Implantation Outcomes after transfemoral transcatheter aortic valve replacement: a comparison of the randomized PARTNER (Placement of AoRTic TraNscathetER Valves) trial with the NRCA (Nonrandomized Continued Access) registry. Thirty-day outcomes in patients at intermediate risk for surgery from the SAPIEN 3 European approval trial. Two-Year Outcomes in Patients With Severe Aortic Valve Stenosis Randomized to Transcatheter Versus Surgical Aortic Valve Replacement: The All-Comers Nordic Aortic Valve Intervention Randomized Clinical Trial Pre-Existing Right Bundle Branch Block Increases Risk for Death After Transcatheter Aortic Valve Replacement With a Balloon-Expandable Valve. Periprocedural bleeding, acute kidney injury, and long-term mortality after transcatheter aortic valve implantation. Temporal changes of new-onset atrial fibrillation in patients randomized to surgical or transcatheter aortic valve replacement. Ventricular arrhythmias in aortic valve stenosis before and after transcatheter aortic valve implantation. Transcatheter or Surgical Aortic-Valve Replacement in Intermediate-Risk Patients. Pacemaker dependency after transcatheter aortic valve implantation with the self-expanding Medtronic CoreValve System. New-onset atrial fibrillation after aortic valve replacement: comparison of transfemoral, transapical, transaortic, and surgical approaches. 1-Year Outcomes After Transcatheter Aortic Valve Replacement With Balloon-Expandable Versus Self-Expandable Valves: Results From the CHOICE Randomized Clinical Trial.
abstract: BACKGROUND After the approval of transcatheter aortic valve replacement ( TAVR ) for high-risk or inoperable patients with severe aortic stenosis ( AS ) , many low- and moderate-volume TAVR programs were initiated . Contemporary outcomes from these newly initiated centres remain unknown . METHODS In March 2013 , our institution was authorized by the Québec Ministry of Health to perform 30 TAVR procedures .  After thorough clinical screening and imaging evaluation , suitable patients underwent transfemoral TAVR with the balloon-exp and able SAPIEN XT ( Edwards Lifesciences , Irvine , CA ) transcatheter heart valve ( THV ) . In-hospital and 30-day outcomes were prospect ively collected and reported according to Valve Academic Research Consortium 2 guidelines . RESULTS From April 2013 to January 2014 , 30 consecutive high-risk ( n = 16 [ 53.3 % ] ) or inoperable ( n = 14 [ 46.7 % ] ) patients ( mean age , 84.6 years ; mean Society of Thoracic Surgery score , 7 ) with symptomatic severe AS underwent transfemoral TAVR . No catastrophic intraprocedural complications such as annulus rupture , valve embolization , aortic dissection , or coronary occlusion occurred , and there were no deaths at 30 days . Disabling stroke occurred in 1 ( 3.3 % ) patient 48 hours after THV implantation . Major vascular complications and major bleeding occurred in 1 ( 3.3 % ) patient . No moderate or severe paravalvular leak was observed . The median length of stay was 2 ( 1 - 3 ) days , with 8 ( 26.7 % ) patients discharged within 24 hours after the procedure . CONCLUSIONS Excellent outcomes can be achieved in newly initiated relatively low-volume centres , which compares favorably to previously published large series . Important considerations include appropriate team training , rigorous patient screening , use of multimodality imaging techniques , a heart team approach , constant integration of lessons learned from larger published experiences , and maintaining a recommended minimum volume of 25 cases per year INTRODUCTION Little is known about the early and late performance of the 31 mm CoreValve Revalving System ( CRS , Medtronic Inc. , Galway , Irel and ) . Our aim was to compare acute and long-term results of the 31 mm CRS with other valve sizes . METHODS Consecutive patients undergoing transcatheter aortic valve implantation ( TAVI ) with CRS in nine Italian centers were prospect ively included and dichotomized according to prosthesis size in two different groups , as follows : 31 mm and other valve sizes ( i.e. , 23 , 26 , and 29 mm combined ) . End points were defined according to Valve Academic Research Consortium definitions . Propensity score matching was performed . RESULTS In total , 2069 patients ( n=169 [ 8 % ] in the 31 mm group and n=1900 [ 92 % ] in the other valve sizes group ) were included . After propensity matching , the implantation of the 31 mm valve was associated with lower rates of procedural- ( 91.3 % vs. 98.1 % , p=0.030 ) and device-success ( 88.5 % vs. 97.1 % , p=0.016 ) , longer procedural time ( 120 [ 80 - 180 ] min . vs. 90 [ 60 - 120 ] min . , p<0.001 ) , and higher rates of implantation of a second valve ( 10.6 % vs. 2.9 % , respectively , p=0.027 ) . The rates of permanent pacemaker implantation in the 31 mm group were higher but not statistically different from other valve sizes ( 41.7 % vs. 30.9 % , respectively , p=0.149 ) . Significant improvement , without between-group differences , was observed in NYHA functional class . Cardiovascular death was lower in the 31 mm valve group through 2-years ( 3.8 % vs. 13.5 % , respectively , p=0.014 ) . CONCLUSIONS The acute performance of the 31 mm CRS was worse than other valve sizes but no negative impact was observed in long-term outcomes OBJECTIVES This study sought to evaluate the incidence , predictive factors , and prognostic value of  new-onset atrial fibrillation ( NOAF ) following transcatheter aortic valve implantation ( TAVI ) .  BACKGROUND Very few data exist on the occurrence of NOAF following TAVI . METHODS A total of 138 consecutive patients with no prior history of atrial fibrillation ( AF ) underwent TAVI with a balloon-exp and able valve . Patients were on continuous electrocardiogram monitoring until hospital discharge , and NOAF was defined as any episode of AF lasting > 30 s. All clinical , echocardiographic , procedural , and follow-up data were prospect ively collected . RESULTS NOAF occurred in 44 patients ( 31.9 % ) at a median time of 48 h ( interquartile range : 0 to 72 h ) following TAVI . The predictive factors of NOAF were left atrial ( LA ) size ( odds ratio [ OR ] : 1.21 for each increase in 1 mm/m(2 ) , 95 % confidence interval [ CI ] : 1.09 to 1.34 , p < 0.0001 ) and transapical approach ( OR : 4.08 , 95 % CI : 1.35 to 12.31 , p = 0.019 ) . At 30-day follow-up , NOAF was associated with a higher rate of stroke/systemic embolism ( 13.6 % vs. 3.2 % , p = 0.021 , p = 0.047 after adjustment for baseline differences between groups ) , with no differences in mortality rate between groups ( NOAF : 9.1 % , no-NOAF : 6.4 % , p = 0.57 ) . At a median follow-up of 12 months ( interquartile range : 5 to 20 months ) , a total of 27 patients ( 19.6 % ) had died , with no differences between the NOAF ( 15.9 % ) and no-NOAF ( 21.3 % ) groups , p = 0.58 . The cumulative rate of stroke and stroke/systemic embolism at follow-up were 13.6 % and 15.9 % , respectively , in the NOAF group versus 3.2 % in the no-NOAF group ( p = 0.039 , adjusted p = 0.037 for stroke ; p = 0.020 , adjusted p = 0.023 for stroke/systemic embolism ) . CONCLUSIONS NOAF occurred in about one-third of the patients with no prior history of AF undergoing TAVI and its incidence was increased in patients with larger LA size and those undergoing transapical TAVI . NOAF was associated with a higher rate of stroke/systemic embolism , but not a higher mortality , at 30 days and at 1-year follow-up INTRODUCTION Transcatheter aortic valve implantation ( TAVI ) is an effective treatment for high-risk or inoperative patients with severe aortic stenosis . Given the unique characteristics of Asian population s , questions regarding mid-term outcomes in Asians undergoing TAVI have yet to be addressed . We evaluated the two-year clinical outcomes of TAVI in an Asian population using Valve Academic Research Consortium-2 definitions . METHODS This prospect i ve study recruited 59 patients from a major academic medical centre in Singapore . The main outcomes were two-year survival rates , peri-procedural complications , symptom improvement , valvular function and assessment of learning curve . RESULTS Mean age was 76.8 years ( 61.0 % male ) , mean body surface area 1.6 m2 and mean logistic EuroSCORE 18.7 % . Survival was 93.2 % , 86.0 % and 79.1 % at 30 days , one year and two years , respectively . At 30 days post TAVI , the rate of stroke was 1.7 % , life-threatening bleeding 5.1 % , acute kidney injury 25.0 % , major vascular complication 5.1 % , and new permanent pacemaker implantation 6.8 % . 29.3 % of TAVI patients were rehospitalised ( 47.1 % cardiovascular-related ) within one year . These composite outcomes were measured : device success ( 93.2 % ) ; early safety ( 79.7 % ) ; clinical efficacy ( 66.1 % ) ; and time-related valve safety ( 84.7 % ) . Univariate analysis found these predictors of two-year all-cause mortality : logistic EuroSCORE ( hazard ratio [ HR ] 1.07 ; p < 0.001 ) ; baseline estimated glomerular filtration rate ( HR 0.97 ; p = 0.048 ) ; and acute kidney injury ( HR 5.33 ; p = 0.022 ) . Multivariate analysis identified non-transfemoral TAVI as a predictor of cardiovascular-related two-year mortality ( HR 14.64 ; p = 0.008 ) . CONCLUSION Despite the unique clinical differences in Asian population s , this registry demonstrated favourable mid-term clinical and safety outcomes in Asians undergoing TAVI BACKGROUND Recent miniaturization of an insertable cardiac monitor ( ICM ) may make it possible to move device insertion from a hospital to office setting . However , the safety of this strategy is unknown . OBJECTIVES The primary objective was to compare the safety of inserting the Reveal LINQ ICM in an office vs a hospital environment . Ancillary objectives included summarizing device- and procedure-related adverse events and responses to a physician question naire . METHODS Five hundred twenty-one patients indicated for an ICM were r and omized ( 1:1 ratio ) to undergo ICM insertion in a hospital or office environment at 26 centers in the United States in the Reveal LINQ In-Office 2 study ( Clinical Trials.gov identifier NCT02395536 ) . Patients were followed for 90 days . RESULTS ICM insertion was successful in all 482 attempted patients ( office : 251 ; hospital : 231 ) . The untoward event rate ( composite of unsuccessful insertion and ICM- or insertion-related complications ) was 0.8 % ( 2 of 244 ) in the office and 0.9 % ( 2 of 227 ) in the hospital ( 95 % confidence interval , -3.0 % to 2.9 % ; 5 % noninferiority : P < .001 ) . In addition , adverse events occurred during 2.5 % ( 6 of 244 ) of office and 4.4 % ( 10 of 227 ) of hospital insertions ( 95 % confidence interval [ office minus inhospital rates ] , -5.8 % to 1.9 % ; 5 % noninferiority : P < .001 ) . Physicians indicated that for procedures performed in an office vs a hospital , there were fewer delays > 15 minutes ( 16 % vs 35 % ; P < .001 ) and patient response was more often " very positive . " Physicians considered the office location " very convenient " more frequently than the hospital location ( 85 % vs 27 % ; P < .001 ) . CONCLUSION The safety profile for the insertion of the Reveal LINQ ICM is excellent irrespective of insertion environment . These results may exp and site of service options for LINQ insertion OBJECTIVES The study sought to examine the safety and performance of transcatheter aortic valve replacement ( TAVR ) using an all-female registry and to further explore the potential impact of female sex-specific characteristics on clinical outcomes after TAVR . BACKGROUND Although women comprise 50 % of patients with symptomatic severe aortic stenosis undergoing TAVR  , the optimal treatment strategy remains undetermined . METHODS The WIN-TAVI ( Women 's INternational Transcatheter Aortic Valve Implantation ) registry is a multinational , prospect i ve , observational registry of women undergoing TAVR for aortic stenosis , conducted without any external funding . The primary endpoint was the Valve Academic Research Consortium (VARC)-2 early safety endpoint at 30 days ( composite of mortality , stroke , major vascular complication , life-threatening bleeding , stage 2 or 3 acute kidney injury , coronary artery obstruction , or repeat procedure for valve-related dysfunction ) . RESULTS Between January 2013 and December 2015 , 1,019 women were enrolled across 19 European and North American centers . The mean patient age was 82.5 ± 6.3 years , mean EuroSCORE I was 17.8 ± 11.7 % and mean Society of Thoracic Surgeons score was 8.3 ± 7.4 % .  TAVR was performed via transfemoral access in 90.6 % and new-generation devices were used in 42.1 % . In more than two-thirds of cases , an Edwards SAPIEN 23 mm ( Edwards Lifesciences , Irvine , California ) or Medtronic CoreValve ≤26 mm ( Medtronic Inc. , Minneapolis , Minnesota ) device was implanted . The 30-day VARC-2 composite endpoint occurred in 14.0 % with 3.4 % all-cause mortality , 1.3 % stroke , 7.7 % major vascular complications , and 4.4 % VARC life-threatening bleeding . The independent predictors of the primary endpoint were age ( odds ratio [ OR ] : 1.04 ; 95 % confidence interval [ CI ] : 1.00 to 1.08 ) , prior stroke ( OR : 2.02 ; 95 % CI : 1.07 to 3.80 ) , left ventricular ejection fraction < 30 % ( OR : 2.62 ; 95 % CI : 1.07 to 6.40 ) , new device generation ( OR : 0.59 ; 95 % CI : 0.38 to 0.91 ) , and history of pregnancy ( OR : 0.57 ; 95 % CI : 0.37 to 0.85 ) . CONCLUSIONS Women enrolled in this first ever all-female TAVR registry with collection of female sex-specific baseline parameters , were at intermediate-high risk and experienced a 30-day VARC-2 composite safety endpoint of 14.0 % with a low incidence of early mortality and stroke . R and omized assessment of TAVR versus surgical aortic valve replacement in intermediate risk women is warranted to determine the optimal strategy Background —Atrial fibrillation ( AF ) is an important risk factor for stroke and is common among elderly patients undergoing transcatheter aortic valve implantation .  The aim of this study was to assess the impact of AF on clinical outcomes among patients undergoing transcatheter aortic valve implantation .  Methods and Results —Between August 2007 and October 2011 , a total of 389 high-risk patients undergoing transcatheter aortic valve implantation  were included into a prospect i ve registry . AF was recorded in 131 patients ( 33.7 % ) with a mean CHA2DS2–VASC score of 4.5±1.2 and was paroxysmal in 26 ( 25.0 % ) , persistent in 8 ( 7.7 % ) , and permanent in 70 patients ( 67.3 % ) . Patients with and without AF had similar baseline characteristics except for fewer revascularization procedures ( coronary artery bypass grafting : 12 % versus 22 % ; P=0.03 ) among AF patients . At 1 year , all-cause mortality was higher among patients with AF ( 30.9 % ) compared with those without AF ( 13.9 % ; hazard ratio [ HR ] , 2.36 ; 95 % confidence interval [ CI ] , 1.43–3.90 ; P=0.0008 ) . This was observed irrespective of the type of AF ( permanent , HR , 2.47 ; 95 % CI , 1.40–4.38 ; persistent , HR , 3.60 ; 95 % CI , 1.10–11.78 ; paroxysmal , HR , 2.88 ; 95 % CI , 1.37–6.05 ) . Mortality gradually increased with higher CHA2DS2–VASC scores ( score 1–3 : HR , 2.20 ; 95 % CI , 0.92–5.27 ; score 6–8 : HR , 4.12 ; 95 % CI , 2.07–8.20 ) . The risks of stroke ( 3.9 % versus 5.1 % ; HR , 0.76 ; 95 % CI , 0.23–1.96 ; P=0.47 ) and life-threatening bleeding ( 19.8 % versus 14.7 % ; HR , 1.37 ; 95 % CI , 0.86–2.19 ; P=0.19 ) were similar among patients with and without AF . Conclusions —AF is common among high-risk patients with severe aortic stenosis undergoing transcatheter aortic valve implantation and is associated with a > 2-fold increased risk of all-cause and cardiovascular mortality , irrespective of the type of AF . The gradient of risk directly correlates with the CHA2DS2–VASC score OBJECTIVES This analysis presents the first report of 1-year outcomes of the 120 patients enrolled in the REPRISE II (  Repositionable Percutaneous Placement of Stenotic Aortic Valve Through Implantation of Lotus Valve System-Evaluation of Safety and Performance ) study . BACKGROUND The fully repositionable and retrievable Lotus Valve ( Boston Scientific , Marlborough , Massachusetts ) was design ed to facilitate accurate positioning , early valve function , and hemodynamic stability during deployment and to minimize paravalvular regurgitation in patients undergoing transcatheter aortic valve replacement . METHODS The study enrolled 120 symptomatic patients 70 years of age or older at 14 centers in Australia and Europe . Patients had severe calcific aortic stenosis and were deemed to be at high or extreme risk of surgery based on assessment by the heart team . RESULTS The mean age was 84.4 ± 5.3 years , 57 % ( 68 of 120 ) of patients were women , and the mean Society of Thoracic Surgeons score was 7.1 ± 4.6 . The mean baseline aortic valve area was 0.7 ± 0.2 cm(2 ) , and the mean transvalvular pressure gradient was 46.4 ± 15.0 mm Hg . All patients were successfully implanted with a Lotus Valve , and 1-year clinical follow-up was available for 99.2 % ( 119 of 120 of patients ) . The mean 1-year transvalvular aortic pressure gradient was 12.6 ± 5.7 mm Hg , and the mean valve area was 1.7 ± 0.5 cm(2 ) . A total of 88.6 % patients had no or trivial paravalvular aortic regurgitation at 1 year by independent core lab adjudication , and 97.1 % of patients were New York Heart Association functional class I or II . At 1 year , the all-cause mortality rate was 10.9 % ( 13 of 119 patients ) , disabling stroke rate was 3.4 % ( 4 of 119 patients ) , disabling bleeding rate was 5.9 % ( 7 of 119 patients ) , with no repeat procedures for valve-related dysfunction . A total of 31.9 % ( 38 of 119 patients ) underwent new permanent pacemaker implantation at 1 year . CONCLUSIONS At 1 year of follow-up , the Lotus Valve demonstrated excellent valve hemodynamics , no moderate or severe paravalvular regurgitation , and significant and sustained improvement in New York Heart Association functional class status , with good clinical outcomes . ( Repositionable Percutaneous Placement of Stenotic Aortic Valve Through Implantation of Lotus Valve System-Evaluation of Safety and Performance [ REPRISE II ] ; NCT01627691 ) BACKGROUND There is limited data from Australia and New Zeal and comparing transcatheter aortic valve implantation ( TAVI ) with conventional surgical aortic valve replacement ( sAVR ) . METHODS Between 2009 and 2015 , 64 patients underwent TAVI and 669 underwent sAVR at a single centre . Patients ' peri-operative details were analysed and compared between groups . Propensity-score matching was performed for risk adjustment . RESULTS Patients receiving TAVI were older ( mean age in years TAVI : 83.9±4.6 vs. sAVR : 71±9.9 , P<0.001 ) , and were more likely to be female  ( TAVI : 67 % , 43/64 , vs. sAVR : 32 % , 217/669 , P < 0.001 ) . Unadjusted 30-day mortality was comparable between groups ( 2/64 , 3 % vs. 22/669 , 3 % , P > 0.99 ) . The matched analysis revealed comparable 30-day mortality  ( TAVI : 2/44 , 5 % vs. sAVR : 2/44 , 5 % , P > 0.99 ) . New atrial arrhythmia occurred more frequently within the sAVR cohort ( TAVI : 1/44 , 2 % vs. sAVR 18/44 , 41 % , P < 0.001 ) . Complete heart block requiring permanent pacemaker was more frequent amongst the TAVI cohort ( TAVI : 10/44 , 23 % vs. sAVR 2/44 , 5 % , P=0.039 ) . At two years , survival was comparable between groups ( TAVI : 74±1.7 vs. sAVR : 80±0.1 % , P=0.65 ) . CONCLUSION This single centre experience suggests that TAVI is a valuable treatment option for high-risk surgical patients with comparable survival Mortality after transcatheter aortic valve implantation ( TAVI )  has been reported to range up to 3 years . However , long-term mortality remains underexplored . The aims of this study were to determine long-term mortality in patients who undergo TAVI  and to identify correlates of long-term death . From a single institution 's prospect ively collected TAVI data base , all patients who underwent TAVI with a maximum follow-up duration of 5 years were analyzed . The population was analyzed on the basis of access route ( transapical TAVI or transfemoral TAVI ) . Cox regression and Kaplan-Meier survival analysis were conducted . A total of 511 patients who underwent TAVI were included in the analysis ( transapical TAVI n = 115 , transfemoral TAVI n = 396 ) . The mean Society of Thoracic Surgeons score was 9.6 ± 4 . Mortality at 30 days ( 18 % vs 6 % , p < 0.001 ) and 1 year ( 32 % vs 21 % , p < 0.01 ) was significantly increased in the transapical TAVI group . Long-term survival probability was < 50 % for the 2 approaches ( log-rank p = 0.33 ) . Vascular complications ( hazard ratio [ HR ] 2.14 , 95 % confidence interval [ CI ] 1.38 to 3.33 , p = 0.001 ) , more than mild aortic insufficiency ( HR 1.81 , 95 % CI 1.15 to 2.83 , p = 0.01 ) , atrial fibrillation ( HR 1.87 , 95 % CI 1.36 to 2.57 , p < 0.001 ) , and in-hospital stroke ( HR 2.35 , 95 % CI 1.39 to 4.00 , p = 0.002 ) were independently associated with long-term death . The survival probability of patients at high surgical risk versus those who were inoperable was similar in the long term ( log-rank p = 0.53 ) . In conclusion , the overall long-term survival of patients with aortic stenosis who were approved to undergo TAVI  was < 50 % irrespective of access method . Strategies geared toward reducing in-hospital stroke , vascular complications , and aortic regurgitation are still needed , as these variables are correlates of long-term mortality INTRODUCTION AND OBJECTIVES Transcatheter aortic valve implantation is used as an alternative to surgical valve replacement in patients with severe aortic stenosis who are considered high-surgical-risk or inoperable . Two of the main areas of uncertainty in this field are valve durability and long-term survival . METHODS This prospect i ve single-center registry study from a tertiary hospital included all consecutive patients who underwent percutaneous aortic valve implantation between 2008 and 2012 . Clinical follow-up lasted a minimum of 2.5 years and a maximum of 6.5 years . Valve Academic Research Consortium-2 definitions were used . RESULTS Seventy-nine patients were included , with an immediate success rate of 94.9 % . The median survival was 47.6 months ( 95 % confidence intervals , 37.4 - 57.9 months ) , ie , 4 years . One quarter of deaths occurred in the first month , and most were of cardiovascular cause . After the first month , most deaths were due to noncardiovascular causes . The mean values of valve gradients did not increase during follow-up . The cumulative rate of prosthetic valve dysfunction was 15.3 % , with no cases of repeat valve replacement . CONCLUSIONS Half of the patients with aortic stenosis who underwent transcatheter aortic valve implantation  were alive 4 years after the procedure . There was a 15.3 % prosthetic valve dysfunction rate in cumulative follow-up , with no cases of repeat valve replacement BACKGROUND We compared transcatheter aortic-valve replacement ( TAVR ) , using a self-exp and ing transcatheter aortic-valve bioprosthesis , with surgical aortic-valve replacement in patients with severe aortic stenosis and an increased risk of death during surgery . METHODS We recruited patients with severe aortic stenosis who were at increased surgical risk as determined by the heart team at each study center . Risk assessment included the Society of Thoracic Surgeons Predictor Risk of Mortality estimate and consideration of other key risk factors . Eligible patients were r and omly assigned in a 1:1 ratio to TAVR with the self-exp and ing transcatheter valve ( TAVR group ) or to surgical aortic-valve replacement ( surgical group ) . The primary end point was the rate of death from any cause at 1 year , evaluated with the use of both noninferiority and superiority testing . RESULTS A total of 795 patients underwent r and omization at 45 centers in the United States . In the as-treated analysis , the rate of death from any cause at 1 year was significantly lower in the TAVR group than in the surgical group ( 14.2 % vs. 19.1 % ) , with an absolute reduction in risk of 4.9 percentage points ( upper boundary of the 95 % confidence interval , -0.4 ; P<0.001 for noninferiority ; P = 0.04 for superiority ) . The results were similar in the intention-to-treat analysis . In a hierarchical testing procedure , TAVR was noninferior with respect to echocardiographic indexes of valve stenosis , functional status , and quality of life . Exploratory analyses suggested a reduction in the rate of major adverse cardiovascular and cerebrovascular events and no increase in the risk of stroke . CONCLUSIONS In patients with severe aortic stenosis who are at increased surgical risk , TAVR with a self-exp and ing transcatheter aortic-valve bioprosthesis was associated with a significantly higher rate of survival at 1 year than surgical aortic-valve replacement . ( Funded by Medtronic ; U.S. CoreValve High Risk Study Clinical Trials.gov number , NCT01240902 . ) Non-r and omised studies of the effects of interventions are critical to many areas of healthcare evaluation , but their results may be biased . It is therefore important to underst and and appraise their strengths and weaknesses . We developed ROBINS-I ( “ Risk Of Bias In Non-r and omised Studies - of Interventions ” ) , a new tool for evaluating risk of bias in estimates of the comparative effectiveness ( harm or benefit ) of interventions from studies that did not use r and omisation  to allocate units ( individuals or clusters of individuals ) to comparison groups . The tool will be particularly useful to those undertaking systematic review s that include non-r and omised studies Introduction The impact of coronary artery disease ( CAD ) on outcomes after transcatheter aortic valve implantation ( TAVI ) has not been clarified . Furthermore , less is known about the indication and strategy of revascularization in these high risk patients . Aims This study sought to determine the prevalence and prognostic impact of CAD in patients undergoing TAVI  , and to assess the safety and feasibility of percutaneous coronary intervention ( PCI ) before TAVI . Methods Patients with severe aortic stenosis ( AS ) undergoing TAVI were included into a prospect i ve single center registry from 2007 to 2012 . Clinical outcomes were compared between patients with and without CAD . In some patients with CAD , it was decided to perform elective PCI before TAVI after decision by the Heart team . The primary endpoints were 30-day and 2-year all-cause mortality . Results A total of 91 consecutive patients with mean age of 79 ± 9 years ( 52 % men )  underwent TAVI with a median follow-up duration of 16 months ( interquartile range of 27.6 months ) . CAD was present on 46 patients ( 51 % ) . At 30-day , the incidences of death were similar between CAD and non-CAD patients ( 9 and 5 % , p = 0.44 ) , but at 2 years were 50 % in CAD patients and 24 % in non-CAD patients [ crude hazard ratio with CAD , 2.2 ; 95 % confidence interval ( CI ) , 1.1–4.6 ; p = 0.04 ] . Adjusting for age , gender , left ventricular ejection fraction , and glomerular filtration rate , the hazard of death was 2.6-fold higher in patients with CAD ( 95 % CI , 1.1–6.0 ; p = 0.03 ) . Elective PCI before TAVI was performed in 13 patients ( 28 % of CAD patients ) . There were no more adverse events in patients who underwent TAVI + PCI when compared with those who underwent isolated TAVI . Conclusion In severe symptomatic AS who underwent TAVI  , CAD is frequent and adversely impacts long-term outcomes , but not procedure outcomes . In selected patients  , PCI before TAVI appears to be feasible and safe OBJECTIVES This study sought to determine whether outcomes for transfemoral ( TF ) transcatheter aortic valve replacement ( TAVR )  differ between the r and omized controlled trial ( RCT ) and the subsequent NRCA ( Nonr and omized Continued Access ) registry of the PARTNER ( Placement of AoRTic TraNscathetER Valves ) trial . BACKGROUND The PARTNER RCT demonstrated that TAVR with the Edwards Sapien valve ( Edwards Lifesciences , Irvine , California ) is noninferior to surgery in high-risk patients and superior to st and ard therapy for inoperable patients . METHODS The inclusion and exclusion criteria , data collection , monitoring , and core laboratories were the same for the RCT and NRCA registry . Baseline characteristics , procedural results , and 1-year outcomes were compared between patients undergoing TF-TAVR  as part of the RCT and as part of the NRCA registry . RESULTS In the RCT , 415 patients underwent TF-TAVR , whereas in the NRCA , 1,023 patients did . At 30 days , death , cardiac death , stroke , and transient ischemic attacks were not different in the NRCA registry than in the RCT . Major vascular complications ( 8.0 % vs. 15.7 % , p < 0.0001 ) and major bleeding ( 6.8 % vs. 15.3 % , p < 0.0001 ) were significantly lower in the NRCA registry . At 1 year , death rates were significantly lower in the NRCA cohort ( 19.0 % vs. 25.3 % , p = 0.009 ) and cardiac death tended to be lower ( 8.4 % vs. 11.1 % , p = 0.12 ) . Stroke or transient ischemic attack ( 6.2 % vs. 8.7 % , p = 0.10 ) and stroke alone ( 5.0 % vs. 7.1 % , p = 0.13 ) also tended to be lower . CONCLUSIONS The large NRCA registry demonstrates further improvement in procedural and longer-term outcomes after TF-TAVR when compared with the favorable results from the PARTNER RCT . ( THE PARTNER TRIAL : Placement of AoRTic TraNscathetER Valve Trial ; NCT00530894 ) AIMS This study sought to investigate outcomes of transcatheter aortic valve implantation ( TAVI ) with the SAPIEN 3 transcatheter heart valve ( THV ) in patients at intermediate risk for surgery . The 30-day results of the transfemoral cohort are reported . METHODS AND RESULTS The SAPIEN 3 European approval trial intermediate-risk cohort included a total of 101 patients with severe , symptomatic aortic stenosis , at intermediate risk for surgery suitable for TAVI via the transfemoral route ( TF ) . Outcomes were adjudicated by a clinical events committee . Echocardiography , computed tomography and electrocardiography exams were analysed in core laboratories . The mean STS-PROM score and logistic EuroSCORE of the study population were 5.2±1.7 and 13.2±3.8 , respectively . A completely percutaneous procedure was performed in 90.1 % of patients and conscious sedation and /or local anaesthesia was utilised in 54.5 % . Technical success was achieved in 98.0 % of patients . At 30 days , mortality was 1.0 % , with stroke in 3.0 % and a new permanent pacemaker in 4.0 % ( 4.3 % of patients without pre-procedural permanent pacemaker ) . No patients had severe aortic regurgitation after the procedure , only one patient had moderate aortic regurgitation , and 70.8 % of patients had no or trace aortic regurgitation . CONCLUSIONS TF-TAVI using the SAPIEN 3 THV in patients at intermediate risk for surgery is associated with a very low risk of death and complications , including new pacemakers and paravalvular leaks . Although compelling , these initial results are being confirmed in larger global studies before exp and ing the indications for TAVI in severe aortic stenosis Background —The Nordic Aortic Valve Intervention ( NOTION ) trial was the first to r and omize all-comers with severe native aortic valve stenosis to either transcatheter aortic valve replacement ( TAVR ) with the CoreValve self-exp and ing bioprosthesis or surgical aortic valve replacement ( SAVR )  , including a lower-risk patient population than previous trials . This article reports 2-year clinical and echocardiographic outcomes from the NOTION trial . Methods and Results —Two-hundred eighty patients from 3 centers in Denmark and Sweden were r and omized to either TAVR  ( n=145 ) or SAVR  ( n=135 ) with follow-up planned for 5 years . There was no difference in all-cause mortality at 2 years between TAVR and SAVR ( 8.0 % versus 9.8 % , respectively ; P=0.54 ) or cardiovascular mortality ( 6.5 % versus 9.1 % ; P=0.40 ) . The composite outcome of all-cause mortality , stroke , or myocardial infa rct ion was also similar ( 15.8 % versus 18.8 % , P=0.43 ) . Forward-flow hemodynamics were improved following both procedures , with effective orifice area significantly more improved after TAVR than SAVR ( effective orifice area , 1.7 versus 1.4 cm2 at 3 months ) . Mean valve gradients were similar after TAVR and SAVR . When patients were categorized according to Society of Thoracic Surgeons Predicted Risk of Mortality ( STS-PROM ) ( < 4 % versus ≥4 % ) , there was no statistically significant difference for TAVR and SAVR groups in the composite outcome for low-risk ( 14.7 % , 95 % confidence interval , 8.3–21.2 versus 16.8 % ; 95 % confidence interval , 9.7–23.8 ; P=0.58 ) or intermediate-risk patients ( 21.1 % versus 27.1 % ; P=0.59 ) . Conclusions —Two-year results from the NOTION trial demonstrate the continuing safety and effectiveness of TAVR in lower-risk patients . Longer-term data are needed to verify the durability of this procedure in this patient population . Clinical Trial Registration —URL : http://www . clinical trials.gov . Unique identifier : NCT01057173 OBJECTIVES The aim of this study was to determine the impact of pre-existing right bundle branch block ( RBBB ) on clinical outcomes after  transcatheter aortic valve replacement ( TAVR ) .  BACKGROUND The impact of pre-existing RBBB on clinical outcomes after TAVR is unknown . METHODS Between October 2013 and August 2015 , 749 patients undergoing TAVR using the Edwards SAPIEN XT prosthesis were prospect ively enrolled in the OCEAN-TAVI ( Optimized Transcatheter Valvular Intervention ) registry from 8 Japanese centers .  Electrocardiograms  were obtained at baseline . After the procedure , follow-up outpatient visits or telephone interviews were conducted at 30 days , 6 months , and yearly . RESULTS A total of 102 patients ( 13.6 % ) had pre-existing RBBB . The incidence of new pacemaker implantation was significantly higher in the RBBB group ( 17.6 % vs. 2.9 % ; p < 0.01 ) . The Kaplan-Meier analysis revealed that cardiovascular survival probability was significantly lower in the RBBB group than the no-RBBB group ( log-rank p < 0.01 ) . Patients with RBBB and without pacemakers were at higher risk for cardiovascular mortality in the early phase after discharge , and patients with RBBB and pacemakers had higher cardiovascular mortality at mid-term follow-up ( log-rank p = 0.01 ) . A multivariate Cox regression model indicated that pre-existing RBBB ( hazard ratio : 2.59 ; 95 % confidence interval : 1.15 to 5.85 ; p < 0.01 ) was an independent predictor of cardiovascular mortality . CONCLUSIONS Patients with RBBB demonstrated an increased risk for cardiovascular mortality after TAVR , and patients with RBBB and without pacemakers were at higher risk for cardiac death early after discharge . Patients with prior RBBB should be carefully monitored after undergoing TAVR BACKGROUND  Acute kidney injury (  AKI ) after transcatheter aortic valve implantation ( TAVI )  is frequent and is associated with adverse outcomes . Past studies have attributed AKI to impaired kidney function at baseline , amount of contrast medium used , major bleeding , and hemodynamic instability during the procedure . Because major bleeding might play a role in the development of AKI , we analyzed the relationship between periprocedural bleeding and the development of AKI and assessed the impact of these 2 important procedure-related complications on outcome . METHODS Consecutive patients undergoing transfemoral TAVI for severe aortic stenosis were prospect ively recruited .  AKI and bleeding events during hospitalization were recorded , defined , and classified according to the Valve Academic Research Consortium 2 definitions . Logistic and Cox regression was used for predictor and survival analyses . RESULTS We recruited 422 consecutive patients who underwent TAVI ; the mean follow-up duration was 576 ± 400 days . AKI occurred in 66 ( 15.6 % ) patients . No patient required dialysis . Fifty patients ( 12 % ) had major or life-threatening bleeding . Periprocedural major or life-threatening bleeding was a strong predictor of the development of AKI ( odds ratio , 3.19 ; 95 % confidence interval [ CI ] , 1.38 - 7.1 ; P = 0.006 ) . Major bleeding was a strong independent predictor for both 30-day and long-term mortality ( hazard ratio [ HR ] , 6.67 ; 95 % CI , 2.2 - 19.8 ; P = 0.001 and HR , 3.3 , 95 % CI , 1.2 - 9.0 ; P = 0.02 , respectively ) , whereas AKI was not independently associated with increased mortality after TAVI . CONCLUSIONS In patients undergoing transfemoral TAVI  , periprocedural bleeding is a strong risk factor for the development of AKI and a major determinant of short- and long-term mortality BACKGROUND Temporal development of new-onset atrial fibrillation ( NOAF ) after aortic valve replacement is unclear , and opportunistic screening has limited diagnostic accuracy . This is the first study to investigate the incidence and temporal development of NOAF detected by implantable loop recorder ( ILR ) in patients with aortic stenosis , r and omized to surgical aortic valve replacement ( SAVR ) or transcatheter aortic valve replacement ( TAVR ) . METHOD An ILR was implanted in a subgroup of patients without pre-procedural atrial fibrillation ( AF ) , r and omized to SAVR or TAVR in the NOTION trial . Data from the ILR were transmitted in intervals of 2weeks for 12weeks post-procedurally and analyzed . RESULTS The study included 25 and 27 patients who underwent SAVR and TAVR , respectively . The cumulative rate of NOAF was 100 % and 81.5 % for patients undergoing SAVR and TAVR , respectively ( P=0.06 ) . TAVR patients without NOAF 6weeks post-procedurally remained free from NOAF . The prevalence of AF after SAVR decreased significantly after 8weeks when compared with the first 2weeks ( 50.0 % vs. 84.0 % , respectively ; P<0.05 ) . The prevalence of AF after TAVR did not change significantly during follow-up . The median AF burden ( percentage of time with AF ) was 2.8 % and 0.04 % during the first 2weeks after SAVR and TAVR , respectively ( P=0.01 ) and it decreased significantly over time after SAVR but not after TAVR . CONCLUSION NOAF subsided 6weeks after TAVR . AF prevalence and burden decreased significantly over time after SAVR , but remained stable after TAVR . These findings may be considered for post-procedural anti-coagulation strategy AIMS Transcatheter aortic valve implantation ( TAVI ) is a therapeutic treatment for patients with severe aortic stenosis ( AS ) at high surgical risk . Although the procedure is associated with a reduction in total mortality , there are no data regarding changing in the incidence of premature ventricular contractions ( PVCs ) and ventricular arrhythmias ( VAs ) after TAVI . The aim of this study was to assess the incidence of VAs before and after TAVI . METHODS AND RESULTS We enrolled 237 patients who underwent TAVI at our centre . Ninety-one patients were excluded for the following reasons : presence of prior permanent pacemaker ( PPM ) ( n = 20 ) , new PPM implant after TAVI ( n = 48 ) , death during the follow-up period ( n = 16 ) , and lost at follow-up ( n = 7 ) . Finally , 146 patients were included in our analysis . The presence of VAs was evaluated in all patients recording a 24 h Holter monitoring before the procedure and after 1 and 12 months . Ventricular arrhythmias were classified according to a modified Lown grading system . Before the procedure , isolates PVCs ( grade 1 - 2 of Lown grading system ) were present in 34.9 % of patients ( n = 51 ) . Complex PVCs ( grade 3 - 4a-4b of Lown grading system ) were present in 48.6 % of the population ( multifocal PVCs in 32 patients , 21.9 % ; pairs in 25 patients , 17.1 % ; ventricular tachycardia in 14 patients , 9.6 % ) . One month after the procedure , we observed statistically significant incidence decrease of arrhythmias of grade 3 ( from 21.9 to 17.1 % ) and grade 4 ( pairs from 17.1 to 12.3 % ; ventricular tachycardia from 9.6 to 4.8 % ) . After 12 months , there was a further significant reduction in the frequency and severity of PVCs . In particular , 45.8 % of patients had isolates PVCs ( < 30 in all given hours of monitoring in 45 patients , 30.8 % ; higher than 30 in any hour of monitoring in 22 patients , 15 % ) while the frequency of complex arrhythmias was reduced to 16.4 % ( multifocal PVCs in 13 patients , 9 % ; couplets 8 patients , 5.5 % and ventricular tachycardia in 3 patients , 2.0 % ) . The difference was statistically significant ( P < 0.01 ) . CONCLUSION This study indicates that VAs are common in patients with AS . We observed a significant decrease in the incidence and severity of PVCs since the first month after TAVI . Furthermore , after 1 year follow-up there was a further and significant reduction in the frequency of complex PVCs . This may be related to the benefits determined by valve replacement on left ventricular function BACKGROUND Previous trials have shown that among high-risk patients with aortic stenosis , survival rates are similar with transcatheter aortic-valve replacement ( TAVR ) and surgical aortic-valve replacement . We evaluated the two procedures in a r and omized trial involving intermediate-risk patients . METHODS We r and omly assigned 2032 intermediate-risk patients with severe aortic stenosis , at 57 centers , to undergo either TAVR or surgical replacement . The primary end point was death from any cause or disabling stroke at 2 years . The primary hypothesis was that TAVR would not be inferior to surgical replacement . Before r and omization , patients were entered into one of two cohorts on the basis of clinical and imaging findings ; 76.3 % of the patients were included in the transfemoral-access cohort and 23.7 % in the transthoracic-access cohort . RESULTS The rate of death from any cause or disabling stroke was similar in the TAVR group and the surgery group ( P=0.001 for noninferiority ) . At 2 years , the Kaplan-Meier event rates were 19.3 % in the TAVR group and 21.1 % in the surgery group ( hazard ratio in the TAVR group , 0.89 ; 95 % confidence interval [ CI ] , 0.73 to 1.09 ; P=0.25 ) . In the transfemoral-access cohort , TAVR result ed in a lower rate of death or disabling stroke than surgery ( hazard ratio , 0.79 ; 95 % CI , 0.62 to 1.00 ; P=0.05 ) , whereas in the transthoracic-access cohort , outcomes were similar in the two groups . TAVR result ed in larger aortic-valve areas than did surgery and also result ed in lower rates of acute kidney injury , severe bleeding , and new-onset atrial fibrillation ; surgery result ed in fewer major vascular complications and less paravalvular aortic regurgitation . CONCLUSIONS In intermediate-risk patients , TAVR was similar to surgical aortic-valve replacement with respect to the primary end point of death or disabling stroke . ( Funded by Edwards Lifesciences ; PARTNER 2 Clinical Trials.gov number , NCT01314313 . ) BACKGROUND / OBJECTIVES To determine pacemaker ( PM ) dependency at follow-up visit in patients who underwent new permanent pacemaker implantation ( PPI ) following transcatheter aortic valve implantation ( TAVI ) .  METHODS Single center prospect i ve observational study including 167 patients without previous PM implantation who underwent TAVI with the self-exp and ing Medtronic CoreValve System ( MCS ) between November 2005 and February 2011 . PM dependency was defined by the presence of a high degree atrioventricular block ( HDAVB ; second [ AV2 ] and third degree [ AV3B ] ) , or a slow ( < 30 bpm ) or absent ventricular escape rhythm during follow-up PM interrogation . RESULTS A total of 36 patients ( 21.6 % ) received a new PM following TAVI . The indication for PM was AV2B ( n=2 , 5.6 % ) , AV3B ( n=28 , 77.8 % ) , postoperative symptomatic bradycardia ( n=3 , 8.3 % ) , brady-tachy syndrome ( n=1 , 2.8 % ) , atrial fibrilation with slow response ( n=1 , 2.8 % ) and left bundle branch block ( n=1 , 2.8 % ) . Long term follow-up was complete for all patients and ranged from 1 to 40 months ( median ( IQR ) : 11.5 ( 5.0 - 18.0 months ) . Of those patients with a HDAVB , 16 out of the 30 patients ( 53.3 % ) were PM independent at follow-up visit ( complete or partial resolution of the AV conduction abnormality ) . Overall , 20 out of the 36 patients ( 55.6 % ) who received a new PM following TAVI were PM independent at follow-up . CONCLUSION Partial and even complete resolution of peri-operative AV conduction abnormalities after MCS valve implantation occurred in more than half of the patients OBJECTIVES This study sought to determine the incidence of  new-onset atrial fibrillation ( AF )  associated with different methods of  isolated aortic valve replacement (AVR)-transfemoral ( TF ) , transapical ( TA ) , and transaortic ( TAo ) catheter-based valve replacement and conventional surgical approaches . BACKGROUND The relative incidences of AF associated with the various access routes for AVR have not been well characterized . METHODS In this single-center , retrospective cohort study , we evaluated a total of 231 consecutive patients who underwent AVR for degenerative aortic stenosis ( AS ) between March 2010 and September 2012 . Patients with a history of paroxysmal , persistent , or chronic AF , with bicuspid aortic valves , and patients who died within 48 h after AVR were excluded . A total of 123 patients ( 53 % of total group ) qualified for inclusion . Data on documented episodes of new-onset AF , along with all clinical , echocardiographic , procedural , and 30-day follow-up data , were collated . RESULTS AF occurred in 52 patients ( 42.3 % ) . AF incidence varied according to the procedural method . AF occurred in 60 % of patients who underwent surgical AVR ( SAVR ) , in 53 % after TA-TAVR , in 33 % after TAo-TAVR cases , and 14 % after TF-TAVR . The episodes occurred at a median time interval of 53 ( 25th to 75th percentile , 41 to 87 ) h after completion of the procedure . Procedures without pericardiotomy had an 82 % risk reduction of AF compared with those with pericardiotomy ( adjusted odds ratio : 0.18 ; 95 % confidence interval : 0.05 to 0.59 ) . CONCLUSIONS AF was a common complication of AVR with a cumulative incidence of > 40 % in elderly patients with degenerative AS who underwent either SAVR or TAVR . AF was most common with SAVR and least common with TF-TAVR . Procedures without pericardiotomy were associated with a lower incidence of AF BACKGROUND The use of a balloon-exp and able transcatheter heart valve previously result ed in a greater rate of device success compared with a self-exp and able transcatheter heart valve . OBJECTIVES The aim of this study was to evaluate clinical and echocardiographic outcome data at longer term follow-up . METHODS The investigator-initiated trial r and omized 241 high-risk patients with symptomatic severe aortic stenosis and anatomy suitable for treatment with both balloon- and self-exp and able transcatheter heart valves to transfemoral transcatheter aortic valve replacement with either device .  Patients were followed-up for 1 year , with assessment of clinical outcomes and echocardiographic evaluation of valve function . RESULTS At 1 year , the rates of death of any cause ( 17.4 % vs. 12.8 % ; relative risk [ RR ] : 1.35 ; 95 % confidence interval [ CI ] : 0.73 to 2.50 ; p = 0.37 ) and of cardiovascular causes ( 12.4 % vs. 9.4 % ; RR : 1.32 ; 95 % CI : 0.63 to 2.75 ; p = 0.54 ) were not statistically significantly different in the balloon- and self-exp and able groups , respectively . The frequencies of all strokes ( 9.1 % vs. 3.4 % ; RR : 2.66 ; 95 % CI : 0.87 to 8.12 ; p = 0.11 ) and repeat hospitalization for heart failure ( 7.4 % vs. 12.8 % ; RR : 0.58 ; 95 % CI : 0.26 to 1.27 ; p = 0.19 ) did not statistically significantly differ between the 2 groups . Elevated transvalvular gradients during follow-up were observed in 4 patients in the balloon-exp and able group ( 3.4 % vs. 0 % ; p = 0.12 ) ; all were resolved with anticoagulant therapy , suggesting a thrombotic etiology . More than mild paravalvular regurgitation was more frequent in the self-exp and able group ( 1.1 % vs. 12.1 % ; p = 0.005 ) . CONCLUSIONS Despite the higher device success rate with the balloon-exp and able valve , 1-year follow-up of patients in CHOICE ( R and omized Comparison of Transcatheter Heart Valves in High Risk Patients With Severe Aortic Stenosis : Medtronic CoreValve Versus Edwards SAPIEN XT Trial ) , with limited statistical power , revealed clinical outcomes after transfemoral transcatheter aortic valve replacement with both balloon- and self-exp and able prostheses that were not statistically significantly different . ( A Comparison of Transcatheter Heart Valves in High Risk Patients With Severe Aortic Stenosis : The CHOICE Trial ; NCT01645202 )
target: 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
background: Objective To evaluate the prevalence and clinical impact of new-onset arrhythmias in patients following transcatheter aortic valve implantation ( TAVI ) .