Abstract
BackgroundPreoperative 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.PurposeWe assessed the impact of preoperative paroxysmal AF on outcome in patients undergoing SAVR with bioprosthesis.MethodsA 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).ResultsPatients in the sinus rhythm and paroxysmal AF groups did not differ with respect to age (P = .484), gender (P = .402) or CHA2DS2‐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).ConclusionPatients 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.
Highlights
Atrial fibrillation (AF) is the most common cardiac tachyarrhythmia
A total of 666 patients undergoing isolated surgical aortic valve replacement (SAVR) with a bioprosthesis were included in the final analysis
Patients were divided into three groups according to the history of preoperative rhythm: sinus rhythm (n = 502), paroxysmal atrial fibrillation (AF) (n = 90), and permanent AF (n = 74)
Summary
The prevalence of AF is 0.5% to 1% in general population, but increases with aging and about 10% of octogenarians have AF.[1,2,3,4] Permanent AF is associated with increased mortality and risk of thromboembolic complications.[5] In particular, the risk is increased in AF patients with comorbidities such as hypertension, heart failure, coronary artery disease, and valvular heart diseases.[4,6,7,8,9] there is still some debate whether AF is an independent predictor of adverse prognosis or whether the worse prognosis among AF patients rather reflects increased age and associated comorbidities It is controversial whether the risk related to AF is equal in patients with paroxysmal and permanent AF.
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