Key result
Preoperative paroxysmal AF is linked to ~70% higher cardiovascular mortality than sinus rhythm in SAVR.
Why the study?
Preoperative permanent AF is associated with impaired outcome after SAVR, but the impact of preoperative paroxysmal AF has remained elusive.
Does preoperative paroxysmal atrial fibrillation increase cardiovascular mortality and fatal strokes in patients undergoing surgical aortic valve replacement with a bioprosthesis compared to sinus rhythm?
Cohort (n=666)
Does preoperative paroxysmal atrial fibrillation increase cardiovascular mortality and fatal strokes in patients undergoing surgical aortic valve replacement with a bioprosthesis compared to sinus rhythm?
Hazard Ratio: 1.7 (95% CI 1.05–2.76)
Absolute Event Rate: 5% vs 3%
p-value: p=0.03
Preoperative paroxysmal AF in patients undergoing SAVR with a bioprosthesis is associated with significantly higher cardiovascular mortality and fatal strokes compared to sinus rhythm, suggesting a potential need for life-long anticoagulation.
Preoperative paroxysmal AF flags higher-risk SAVR patients; leaves open whether anticoagulation improves survival.
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: -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.
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Nissinen et al. (2020) conducted a cohort in Surgical aortic valve replacement with a bioprosthesis (n=666). Preoperative paroxysmal atrial fibrillation vs. Preoperative sinus rhythm was evaluated on Cardiovascular mortality (HR 1.70, 95% CI 1.05-2.76, p=0.03). Preoperative paroxysmal AF in patients undergoing surgical aortic valve replacement was associated with higher cardiovascular mortality than sinus rhythm (HR 1.70; 95% CI 1.05-2.76; P=0.03).
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