AF in Chronic Aortic Regurgitation Tied to Mortality Risk

TOPLINE:

Atrial fibrillation (AF) was present in 1 in 6 patients with chronic aortic regurgitation — either moderate-to-severe or severe — and was independently associated with an increased risk for mortality and more severe symptoms.

METHODOLOGY:

• Researchers conducted a retrospective cohort study to determine the prevalence and prognostic significance of AF in patients with hemodynamically significant aortic regurgitation.
• The study included 1006 patients (mean age, 59 years; 82% men) with moderate-to-severe chronic aortic regurgitation between March 2004 and April 2019.
• AF was identified using ECG and episodes were recorded by implanted cardiac devices.
• The primary endpoint was all-cause mortality. Inclusion was halted for patients who received an aortic valve replacement.

TAKEAWAY:

• AF was present in 16% of patients at the time of diagnosis of chronic aortic regurgitation. Those with AF were more likely to be older (adjusted odds ratio [aOR] per year increase, 1.06), men (aOR, 3.55), and have a diagnosis of congestive heart failure (aOR, 2.11; P ≤ .001 for all).
• AF was independently associated with a significantly elevated risk for mortality in all three multivariable models even after adjusting for comorbid conditions and left ventricular systolic and diastolic function, with hazard ratios ranging from 1.61 to 2.21 (P < .05 for all).
• Patients with AF had more severe symptoms and a higher risk for death than those with sinus rhythm (P < .05 for both).
• The median duration between the diagnoses of AF and aortic regurgitation was 2.1 years, and AF was usually paroxysmal.

IN PRACTICE:

The findings “highlight the need for a more comprehensive evaluation of cardiac function, including assessment of AF, in patients with chronic, hemodynamically significant [aortic regurgitation] rather than focusing solely” on left ventricle systolic function, the researchers reported. The results also underscore the need for prospective studies “to validate risk factors for the development of AF in chronic [aortic regurgitation] and to assess whether the onset of AF could aid in risk stratification, including the timing of intervention,” they added.

SOURCE:

This study was led by Giordano M. Pugliesi, MD, of the University of Milan-Bicocca in Milan, Italy. It was published online on July 16, 2025, in Heart. The findings were previously presented as a poster at the American College of Cardiology (ACC) Scientific Session 2025 in Chicago.

LIMITATIONS:

The retrospective analysis had incomplete data on comorbidities, cerebral embolic events, hospitalizations for heart failure, and causes of death. Lack of systematic screening may have underestimated the prevalence of AF. This study was conducted at a single tertiary center, potentially introducing referral bias.

DISCLOSURES:

This study received support through an intramural grant by Mayo Clinic. The authors declared having no competing interests.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.