Clinical Significance of Ventricular Tachyarrhythmias in Patients Undergoing Valve Replacement: A Nationwide Population-Based Study

Guan-Yi Li; Yun-Yu Chen; Kuo-Liong Chien; Yenn-Jiang Lin; Tzu-Ting Kuo; Fa-Po Chung

doi:10.3389/fcvm.2021.676897

Clinical Significance of Ventricular Tachyarrhythmias in Patients Undergoing Valve Replacement: A Nationwide Population-Based Study

Front Cardiovasc Med. 2021 Jul 15:8:676897. doi: 10.3389/fcvm.2021.676897. eCollection 2021.

Authors

Guan-Yi Li¹, Yun-Yu Chen^{1

2}, Kuo-Liong Chien², Yenn-Jiang Lin^{1

3}, Tzu-Ting Kuo^{4

5}, Fa-Po Chung^{1

3}

Affiliations

¹ Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
² Institute of Epidemiology and Preventive Medicine College of Public Health, National Taiwan University, Taipei, Taiwan.
³ Institute of Clinical Medicine and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan.
⁴ Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.
⁵ Department of Medicine, School of Medicine, National Yang Ming University, Taipei, Taiwan.

Abstract

Background: The clinical significance and outcomes of ventricular tachyarrhythmias (VTa) in patients undergoing valve replacement have rarely been reported. Objective: This study aimed to investigate the incidence and outcome of VTa after surgical valve replacement. Methods: We conducted a population-based retrospective cohort study using data obtained from the Taiwan National Health Insurance Research Database. In total, 10,212 patients were selected after 1:1 propensity-score matching based on the type of prosthetic valve used (mechanical vs. bioprosthetic). Various outcomes during long-term follow-up were analyzed. Results: After a median follow-up period of 59.6 months, the crude incidence rate of VTa after surgical valve replacement was 4.8/1,000 person-years, and the cumulative incidence of VTa persistently increased after surgery. Furthermore, the occurrences of VTa after valve replacement significantly increased the risk of cardiovascular (CV) death (P < 0.001, HR 1.67, 95% CI 1.41-1.96), stroke- (P < 0.001, HR 1.66, 95% CI 1.37-2.01), atrial fibrillation- (P < 0.001, HR 2.80, 95% CI 2.42-3.24), and congestive heart failure-related hospitalization (P < 0.001, HR 2.61, 95% CI 2.30-2.95). Among patients with VTa, all-cause mortality (P = 0.001, HR 0.49, 95% CI 0.32-0.75) and CV death (P = 0.047, HR 0.58, 95% CI 0.34-0.99) in those with implantable cardioverter-defibrillator (ICD) implantation were lower than those without. Conclusion: The crude incidence rate of VTa after surgical valve replacement was 4.8/1,000 person-years, and the cumulative incidence of VTa persistently increased during follow-up. The presence of VTa after surgical valve replacement increases hospitalization and CV death, while ICD implantation reduced the mortality rate in these patients.

Keywords: bioprosthetic valve; implantable cardioverter-defibrillator; mechanical valve; valve replacement; ventricular tachyarrhythmia.