IntroductionNew-onset postoperative atrial fibrillation (AF) is a frequent complication after open-heart surgery and cardioversions (CV) are often performed to restore sinus rhythm in this setting. ...Thromboembolic risk related to early postoperative CV and the recurrence of AF in the long-term follow-up, however, remain largely unknown.HypothesisThe FIN-bioAVR study sought to assess the rate of strokes and transient ischemic attacks (TIA) shortly after CV for AF in patients who underwent isolated aortic valve replacement with bioprosthesis.MethodsBetween 2002 and 2014, 784 patients underwent isolated aortic valve replacement with a bioprosthesis in four Finnish University Hospitals.ResultsDuring postoperative hospitalization when patients with prior chronic AF were excluded, 368/685 (53.7%) of patients had at least one new-onset paroxysm of AF (median time to diagnosis 3 3 days), and early CV was performed in 122/368 (33.2%) of them. Baseline characteristics were comparable except that patients with CV had more often prior diagnosis of heart failure and less often chronic lung disease compared to those without CV. Hospital stay was significantly shorter, but at two-weeks follow-up, the rate of stroke/TIAs was 3.3% vs. 0.4% (p=0.05) in those with vs. without CV, respectively. Strikingly, early CV was associated with a trend of increased risk of two-week stroke/TIA rate compared to patients without CV (OR 7.66 (95%-CI 0.85-69.3, p=0.07)). In the median follow-up of 1682 1514 days patients with early CV had more often recurrences of clinical AF (57% vs. 39%, p<0.01).ConclusionsIn this large real-world population of patients undergoing aortic valve bioprosthesis operation, the rate of new-onset in-hospital AF was over 50%. Nearly third of them had a CV and these patients had over 7-fold risk for thromboembolisms related to CV.
Abstract
Aims
Post-operative atrial fibrillation (POAF) is a frequent complication after open-heart surgery, and cardioversions (CV) are commonly performed to restore sinus rhythm. However, little ...data exists on thrombo-embolic risk related to early post-operative CV and on the recurrence of POAF after CV. CAREAVR study sought to assess the rate of strokes, transient ischaemic attacks (TIA), and mortality shortly after POAF-triggered CV in patients who underwent isolated surgical aortic valve replacement (SAVR) with a bioprosthesis.
Methods and results
Altogether 721 patients underwent isolated SAVR with a bioprosthesis at four Finnish university hospitals. During post-operative hospitalization, after patients with prior chronic AF were excluded, 309/634 (48.7%) of patients had at least one episode of POAF median time (interquartile range) 3 (3) days, and an electrical CV was performed in 113/309 (36.6%) of them. The length of hospital stay was not affected by CV. At 30 days follow-up, the rate of stroke, TIA or mortality was higher in those AF patients who underwent CV vs. those who did not (9.7% vs. 3.6%, P = 0.04, respectively; adjusted hazard ratio 2.63, 95% confidence interval 1.00–6.92, P = 0.05). Similar proportion of patients in both groups were in AF rhythm at discharge (32.7% vs. 35.7%, P = 0.18); and at 3 months (25.0% vs. 23.6%, P = 0.40), respectively.
Conclusion
In this real-world population of patients undergoing isolated SAVR, the rate of POAF was nearly 50%. One-third of these patients underwent an electrical CV, and they exhibited over two-fold risk for thromboembolisms and mortality. Cardioversion did not affect the short-term prevalence of AF.
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