Key result
In-hospital new-onset atrial fibrillation after surgical aortic valve replacement was associated with an increased risk of late atrial fibrillation (HR 3.68; 95% CI 2.82-4.81; P<.0001).
Why the study?
More knowledge was needed regarding long-term AF recurrence and adverse outcomes related to in-hospital new-onset AF after cardiac surgery.
Does in-hospital new-onset atrial fibrillation increase the risk of late AF recurrence and mortality in patients undergoing isolated surgical aortic valve replacement?
Cohort (n=782)
Yes
Does in-hospital new-onset atrial fibrillation increase the risk of late AF recurrence and mortality in patients undergoing isolated surgical aortic valve replacement?
Hazard Ratio: 3.68 (95% CI 2.82–4.81)
p-value: p=<.0001
New-onset atrial fibrillation during the index hospitalization for surgical aortic valve replacement is associated with a significantly increased risk of late AF recurrence and all-cause mortality.
In-hospital NOAF was associated with higher postdischarge AF; leaves open whether targeted monitoring improves outcomes.
OBJECTIVES: Atrial fibrillation (AF) is a common complication after cardiac surgery. More knowledge is needed about long-term AF recurrence and adverse outcomes related to new-onset AF (NOAF) during the index hospitalization. METHODS: A total of 1073 patients underwent isolated surgical aortic valve replacement at the 4 participating hospitals (2002-2014). After the exclusion of patients with a history of any preoperative AF, the final study population included 529 patients in the bioprosthetic and 253 patients in the mechanical valve prosthesis cohort. Median follow-up time was 5.4 (interquartile range, 3.4-8.2) years in the combined cohort. RESULTS: Altogether 333 (42.6%) patients had in-hospital NOAF and 250 (32.0%) AF after hospital discharge. In the mechanical cohort, 64 (25.3%) experienced in-hospital NOAF and 74 (29.2%) AF after hospital discharge, whereas in the bioprosthetic cohort, 269 (50.9%) patients had in-hospital NOAF and 176 (33.3%) AF after hospital discharge. Patients with NOAF during the index hospital stay had a multifold risk of AF after hospital discharge in the combined cohort (hazard ratio [HR], 3.68; 95% confidence interval [CI], 2.82-4.81; P < .0001) as well as in both cohorts separately (bioprosthetic: HR, 4.35; 95% CI, 3.05-6.22; P < .001; mechanical: HR, 2.54; 95% CI, 1.59-4.03; P < .001). Patients with an in-hospital NOAF also had a significantly higher adjusted risk of death during the follow-up in the mechanical (HR, 2.05; 95% CI, 1.10-3.82; P = .025) and bioprosthetic (HR, 1.63; 95% CI, 1.17-2.28; P = .004) valve prosthesis cohorts. CONCLUSIONS: NOAF during the index hospitalization is associated with a 2- to 4-fold risk of later AF and 1.6- to 2.0-fold risk of all-cause mortality after mechanical and bioprosthetic surgical aortic valve replacement.
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Björn et al. (2021) conducted a cohort in Isolated surgical aortic valve replacement (n=782). New-onset atrial fibrillation (NOAF) during index hospitalization vs. No in-hospital NOAF was evaluated on Atrial fibrillation after hospital discharge (HR 3.68, 95% CI 2.82-4.81, p=<.0001). In-hospital new-onset atrial fibrillation after surgical aortic valve replacement was associated with an increased risk of late atrial fibrillation (HR 3.68; 95% CI 2.82-4.81; P<.0001).
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