Author + information
- Tanyanan Tanawuttiwat,
- Brian O'Neill,
- Conrad Macon,
- Thomas Lucero,
- Orawee Chinthakanan,
- Alan Heldman,
- Mauricio Cohen,
- William O'Neill,
- Donald Williams and
- Robert Myerburg
New-onset atrial fibrillation (AF) after valvular surgery is associated with prolonged hospital stay, and increased mortality and morbidity. Our objective was to determine the incidence of New-onset AF associated with different methods of isolated aortic valve replacement(AVR): transfemoral (TF), transapical (TA), transaortic (TAo) and surgical (S) groups.
In a single-center, retrospective cohort, we evaluated consecutive patients undergoing AVR for degenerative aortic stenosis (AS) between March 2010 and September 2012. After excluding patients with a history of either chronic or paroxysmal AF, with bicuspid aortic valve, and patients who expired within 48 hours after AVR, 123 patients were included. Patients remained on electrocardiographic monitoring until hospital discharge. Documented episodes of AF, along with all clinical, echocardiographic, procedural and 30-day follow up data, were collected.
AF occurred in 52 patients (42.3%). The distribution of AF according to method was: S = 21/35 (60%), TA = 19/36 (53%); TAo = 8/24 (33%); and TF = 4/28 (14%). The episodes occurred at a median time of 53 hours (Interquatile range = 46); 65% of AF events lasted less than 24 hours. The procedures requiring pericardiotomy (S and TA) had more than 5 times higher risk of AF than those without pericardiotomy (TF and TAo) (adjusted odds ratio [a0R] 5.64, 95% CI 1.69–18.81). Of note, procedures performed through a chest wall incision (TA, TAo, and S vs. TF; a0R 3.10, 95% CI 0.08-12.43) or non-transcatheter (S vs. TF, TA, and TAo; aoR 1.57, 95% CI 0.59-4.21) were not significantly associated with increased risk of AF. The mean duration of postoperative hospitalization was longer among patients who developed AF (10.2 vs 9.1 days, p value < 0.001).
Among patients with degenerative AS and no prior history of AF who underwent isolated AVR, AF is a relatively common complication with an incidence > 40% in our study. AF was most common with surgical AVR and least seen after transfemoral AVR. Procedures requiring pericardiotomy were associated with a higher risk of AF. The awareness and therapeutic implications of our findings warrant further study.
Poster Sessions, Expo North
Sunday, March 10, 2013, 9:45 a.m.-10:30 a.m.
Session Title: Arrhythmias: AF/SVT V
Abstract Category: 4. Arrhythmias: AF/SVT
Presentation Number: 1189-32
- 2013 American College of Cardiology Foundation