Preoperative paroxysmal atrial fibrillation predicts high cardiovascular mortality in patients undergoing surgical aortic valve replacement with a bioprosthesis: CAREAVR study.
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
Patients in the sinus rhythm and paroxysmal AF groups did not differ with respect to age (P = .484), gender (P = .402) or CHA2 DS2 -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.
['Nissinen|Maunu|M|https://orcid.org/0000-0001-8745-9065', 'Lehto|Joonas|J|', 'Biancari|Fausto|F|https://orcid.org/0000-0001-5028-8186', 'Nieminen|Tuomo|T|', 'Malmberg|Markus|M|', 'Yannopoulos|Fredrik|F|', 'Salmi|Samuli|S|https://orcid.org/0000-0002-6776-1504', 'Airaksinen|Juhani K E|JKE|https://orcid.org/0000-0002-0193-568X', 'Kiviniemi|Tuomas|T|https://orcid.org/0000-0002-0908-3741', 'Hartikainen|Juha E K|JEK|']
D000368:Aged D000369:Aged, 80 and over D001021:Aortic Valve D001281:Atrial Fibrillation D001705:Bioprosthesis D005260:Female D005387:Finland D006349:Heart Valve Diseases D006350:Heart Valve Prosthesis D019918:Heart Valve Prosthesis Implantation D006439:Hemodynamics D006801:Humans D008297:Male D012042:Registries D012189:Retrospective Studies D012307:Risk Factors D020521:Stroke D013997:Time Factors D016896:Treatment Outcome
paroxysmal atrial fibrillation mortality aortic valve replacement bioprosthesis stroke