University of Oulu

Tuomas Kiviniemi, Markus Malmberg, Fausto Biancari, Juha Hartikainen, Leo Ihlberg, Fredrik Yannopoulos, Teemu Riekkinen, Otto von Hellens, Joonas Lehto, Maunu Nissinen, Ke Juhani Airaksinen, Tuomo Nieminen, Thromboembolisms related to post-operative electrical cardioversions for atrial fibrillation in patients with surgical aortic valve replacement, European Heart Journal - Quality of Care and Clinical Outcomes, Volume 4, Issue 2, April 2018, Pages 120–125,

Thromboembolisms related to post-operative electrical cardioversions for atrial fibrillation in patients with surgical aortic valve replacement

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Author: Kiviniemi, Tuomas1; Malmberg, Markus1; Biancari, Fausto1,2;
Organizations: 1Heart Center, Turku University Hospital and University of Turku, Hämeentie 11, 20521 Turku, Finland
2Department of Surgery, Oulu University Hospital and University of Oulu, Oulu, Finland
3Heart Center, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
4Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Internal Medicine, Helsinki, Finland
5South Karelia Central Hospital, Internal Medicine, Lappeenranta, Finland
Format: article
Version: accepted version
Access: open
Online Access: PDF Full Text (PDF, 0.2 MB)
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Language: English
Published: Oxford University Press, 2018
Publish Date: 2019-10-21


Aims: Post-operative atrial fibrillation (POAF) is a frequent complication after open-heart surgery, and cardioversions (CV) are commonly performed to restore sinus rhythm. However, little data exists on thrombo-embolic risk related to early post-operative CV and on the recurrence of POAF after CV. CAREAVR study sought to assess the rate of strokes, transient ischaemic attacks (TIA), and mortality shortly after POAF-triggered CV in patients who underwent isolated surgical aortic valve replacement (SAVR) with a bioprosthesis.

Methods and results: Altogether 721 patients underwent isolated SAVR with a bioprosthesis at four Finnish university hospitals. During post-operative hospitalization, after patients with prior chronic AF were excluded, 309/634 (48.7%) of patients had at least one episode of POAF [median time (interquartile range) 3 (3) days], and an electrical CV was performed in 113/309 (36.6%) of them. The length of hospital stay was not affected by CV. At 30 days follow-up, the rate of stroke, TIA or mortality was higher in those AF patients who underwent CV vs. those who did not (9.7% vs. 3.6%, P = 0.04, respectively; adjusted hazard ratio 2.63, 95% confidence interval 1.00–6.92, P = 0.05). Similar proportion of patients in both groups were in AF rhythm at discharge (32.7% vs. 35.7%, P = 0.18); and at 3 months (25.0% vs. 23.6%, P = 0.40), respectively.

Conclusion: In this real-world population of patients undergoing isolated SAVR, the rate of POAF was nearly 50%. One-third of these patients underwent an electrical CV, and they exhibited over two-fold risk for thromboembolisms and mortality. Cardioversion did not affect the short-term prevalence of AF.

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Series: European heart journal. Quality of care & clinical outcomes
ISSN: 2058-5225
ISSN-E: 2058-1742
ISSN-L: 2058-5225
Volume: 4
Issue: 2
Pages: 120 - 125
DOI: 10.1093/ehjqcco/qcy003
Type of Publication: A1 Journal article – refereed
Field of Science: 3121 General medicine, internal medicine and other clinical medicine
Funding: Finnish Medical Foundation, the Finnish Foundation for Cardiovascular Research, Helsinki, Finland; State Clinical Research Fund (EVO) of Turku University Hospital, Turku, Finland; the Emil Aaltonen Foundation, the Maud Kuistila Foundation; an unrestricted grant from Bristol-Myers-Squibb-Pfizer.
Copyright information: Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2018. This is a pre-copyedited, author-produced version of an article accepted for publication in European Heart Journal - Quality of Care and Clinical Outcomes following peer review. The version of record [insert complete citation information here] is available online at: