Preoperative Paroxysmal Atrial Fibrillation Predicts High Cardiovascular Mortality in Patients Undergoing Surgical Aortic Valve Replacement with a Bioprosthesis: CAREAVR Study

Overview

Journal Clin Cardiol

Specialty Cardiology & Vascular Diseases

Date 2020 Feb 6

PMID 32022308

Citations 1

Authors

Maunu Nissinen

Joonas Lehto

Fausto Biancari

Tuomo Nieminen

Markus Malmberg

Fredrik Yannopoulos

Samuli Salmi

Juhani K E Airaksinen

Tuomas Kiviniemi

Juha E K Hartikainen

Affiliations

Soon will be listed here.

Abstract

Background: Preoperative permanent atrial fibrillation (AF) is associated with impaired outcome after surgical aortic valve replacement (SAVR). The impact of preoperative paroxysmal AF, however, has remained elusive.

Purpose: We assessed the impact of preoperative paroxysmal AF on outcome in patients undergoing SAVR with bioprosthesis.

Methods: A total of 666 patients undergoing isolated AVR with a bioprosthesis were included. Survival data was obtained from the national registry Statistics Finland. Patients were divided into three groups according to the preoperative rhythm: sinus rhythm (n = 502), paroxysmal AF (n = 90), and permanent AF (n = 74).

Results: Patients in the sinus rhythm and paroxysmal AF groups did not differ with respect to age (P = .484), gender (P = .402) or CHA DS -VASc score (P = .333). At 12-month follow-up, AF was present in 6.2% of sinus rhythm patients and in 42.4% of paroxysmal AF patients (P < .001). During follow-up, incidence of fatal strokes in the paroxysmal AF group was higher compared to sinus rhythm group (1.9 vs 0.4 per 100 patient-years, HR 4.4 95% Cl 1.8-11.0, P = .001). Cardiovascular mortality was higher in the paroxysmal AF group than in the sinus rhythm group (5.0 vs 3.0 per 100 patient-years, HR 1.70 95% CI 1.05-2.76, P = .03) and equal to patients in the permanent AF (5.0 per 100 patient-years).

Conclusion: Patients undergoing SAVR with bioprosthesis and history of paroxysmal AF had higher risk of developing permanent AF, cardiovascular mortality and incidence of fatal strokes compared to patients with preoperative sinus rhythm. Life-long anticoagulation should be considered in patients with a history of preoperative paroxysmal AF.

Citing Articles

Preoperative paroxysmal atrial fibrillation predicts high cardiovascular mortality in patients undergoing surgical aortic valve replacement with a bioprosthesis: CAREAVR study.

Nissinen M, Lehto J, Biancari F, Nieminen T, Malmberg M, Yannopoulos F Clin Cardiol. 2020; 43(4):401-409.

PMID: 32022308 PMC: 7144481. DOI: 10.1002/clc.23329.

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