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. 2024 Oct;168(4):1073-1079.
doi: 10.1016/j.jtcvs.2023.08.057. Epub 2023 Sep 12.

Postoperative atrial fibrillation in mitral valve surgery is not benign

Whitney Fu  1 , China Green  2 , Catherine Wagner  2 , Gurnoordeep Pawar  2 , Nicolas Ceniza  2 , Rhea Gupta  2 , Corina Ghita  2 , Marco Bologna  2 , Dani Ahmetovic  2 , Tanvi Ravi  2 , Jack Proebstle  2 , Vivica Addrow  2 , Matthew Romano  2 , Gorav Ailawadi  2 , Steven F Bolling  2
Affiliations

Postoperative atrial fibrillation in mitral valve surgery is not benign

Whitney Fu et al. J Thorac Cardiovasc Surg. 2024 Oct.

Abstract

Objective: Postoperative atrial fibrillation (POAF) is common after cardiac surgery and is often considered to be benign despite recent data suggesting worse outcomes. There are no guidelines for the amount of POAF that triggers anticoagulation or for postoperative surveillance. We examined the rate of POAF, incidence of neurologic events, development of permanent atrial fibrillation, and mortality in patients undergoing isolated mitral valve surgery at a Mitral Foundation reference center.

Methods: This is a retrospective cohort study of 922 adult patients from 2011 to 2022 with no preoperative history of arrhythmias. Multivariable logistic regression was used to identify independent risk factors for the primary outcomes. Kaplan-Meier analysis and Cox proportional-hazards model were used to characterize long-term survival.

Results: The incidence of POAF was 39%. Median follow-up was 4.9 months (interquartile range, 1.1-42.6 months). Diabetes (odds ratio [OR], 2.2; 95% CI, 1.2-4.1; P = .01) and increasing age (OR, 1.1; 95% CI, 1.0-1.1; P < .001) were risk factors for POAF, whereas New York Heart Association functional class was not. POAF was a risk factor for the development of permanent atrial fibrillation (OR, 3.2; 95% CI 1.9-5.4; P < .001), which was associated with increased risk of neurologic events (OR, 3.8; 95% CI, 1.5-9.7; P = .004). Ultimately, patients with POAF had worse unadjusted (P < .001) and adjusted long-term mortality (hazard ratio, 1.8; 95% CI, 1.1-3.1; P = .03).

Conclusions: POAF is associated with an increased rate of neurologic events, portends development of permanent atrial fibrillation, and is associated with worse long-term survival. POAF is not benign and carries a long-term mortality implication.

Keywords: mitral valve surgery; mortality; permanent atrial fibrillation; postoperative atrial fibrillation.

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Conflict of interest statement

Conflict of Interest Statement Dr Romano is a consultant for Edwards Lifesciences, Medtronic, and Atricure. Dr Ailawadi is a consultant for Abbott Laboratories, Edwards Lifesciences, Medtronic, Anteris Technologies, Atricure, and Gore Medical. Dr Bolling is a consultant for Abbott Laboratories, Edwards Lifesciences, Medtronic, Atricure, and Gore Medical. Dr Wagner received salary support through the Institute of Healthcare Policy and Innovation as a part of the National Clinician Scholars Program. Dr Fu is supported by a National Institutes of Health T32 Multidisciplinary Training Program in Lung Disease (No. T32HL007749). All other authors reported no conflicts of interest. The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling manuscripts for which they may have a conflict of interest. The editors and reviewers of this article have no conflicts of interest.

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