Early postoperative AF (OR 5.93; 95% CI 2.96-11.8), previous AF, and higher BMI independently predicted mid-term atrial fibrillation after bioprosthetic aortic valve replacement.
Cohort (n=219)
Mid-term postoperative atrial fibrillation is common (20.4%) after bioprosthetic aortic valve replacement, particularly in overweight patients with early POAF, suggesting a potential need for anticoagulation rather than antiplatelet therapy alone.
Effect estimate: OR 5.93 (95% CI 2.96-11.8)
BACKGROUND: Little is known about mid-term (3-month) postoperative atrial fibrillation (MT-POAF) in patients treated with bioprosthetic aortic valve replacement (BAVR). The aim of this study was to describe the natural history, identify the predictors and investigate the potential consequences in terms of anti-thrombotic therapy. METHODS AND RESULTS: During a longitudinal, prospective study, 219 patients were treated with BAVR early (7 days) and at mid-term postoperatively (30 and 90 days). POAF was monitored and risk factors were identified on logistic regression analysis. History of previous AF (OR, 3.08; 95% CI: 1.35-6.98), early POAF (OR, 5.93; 95% CI: 2.96-11.8), and BMI (per 5 kg/m(2): OR, 1.46; 95% CI: 1.03-2.09), were independent predictors for MT-POAF whereas sex, age and Euroscore were not. Results were identical when restricted to the 176 patients free from preoperative AF. In this subgroup, 36 patients (20.4%) had MT-POAF; 33 out of 174 (18.7%) would have required anticoagulation (CHA2DS2VASc score ≥ 1). Conversely, patients with BMI <27.7 and sinus rhythm at early follow-up had a very low risk of MT-POAF (OR, 0.16; 95% CI: 0.06-0.42). CONCLUSIONS: There was a higher than expected occurrence of MT-POAF in patients treated with BAVR, particularly in overweight patients with early POAF. This raises the question of implementing an anti-thrombotic therapy in these patients at higher risk of delayed atrial arrhythmia.
Tosello et al. (Wed,) conducted a cohort in Postoperative atrial fibrillation (n=219). Bioprosthetic aortic valve replacement was evaluated on Mid-term postoperative atrial fibrillation (MT-POAF) (OR 5.93, 95% CI 2.96-11.8). Early postoperative AF (OR 5.93; 95% CI 2.96-11.8), previous AF, and higher BMI independently predicted mid-term atrial fibrillation after bioprosthetic aortic valve replacement.