New-onset or newly detected atrial fibrillation after transcatheter aortic valve implantation?

Diagnosis of new-onset atrial fibrillation (AF) in elderly patients with severe symptomatic aortic stenosis undergoing transcatheter aortic valve implantation (TAVI) has important acute and long-term implications in clinical decision-making. In this issue of EuroIntervention, Nuche et al1 report the results of a multicentre study in patients with severe aortic stenosis and no previously known AF undergoing TAVI who were monitored by means of different methods of continuous ambulatory electrocardiogram (ECG) recording devices. The analysis was conducted retrospectively on prospectively collected data. New-onset AF was detected in 7% of the patients and resulted in the initiation of long-term oral anticoagulation therapy in half of these patients; it was not associated with impaired clinical outcomes up to 1 year of follow-up.

This study is published at a time when the widespread adoption of continuous rhythm monitoring devices has facilitated the identification of individuals with non-clinically overt manifestations of AF, leading to the recognition of a new entity within the AF spectrum called subclinical AF. The prevalence of subclinical AF increases with advancing age and may be as high as 30%,...