University of Oulu

Nissinen, M, Lehto, J, Biancari, F, et al. Preoperative paroxysmal atrial fibrillation predicts high cardiovascular mortality in patients undergoing surgical aortic valve replacement with a bioprosthesis: CAREAVR study. Clin Cardiol. 2020; 43: 401– 409.

Preoperative paroxysmal atrial fibrillation predicts high cardiovascular mortality in patients undergoing surgical aortic valve replacement with a bioprosthesis : CAREAVR study

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Author: Nissinen, Maunu1; Lehto, Joonas2; Biancari, Fausto2,3;
Organizations: 1Heart Center, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
2Heart Center, Turku University Hospital and University of Turku, Turku, Finland
3Department of Surgery, Oulu University Hospital, Oulu, Finland
4Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
5Department of Internal Medicine, South Karelia Central Hospital, Lappeenranta, Finland
6Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 1.6 MB)
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Language: English
Published: John Wiley & Sons, 2020
Publish Date: 2020-06-09


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 CHA₂DS₂‐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.

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Series: Clinical cardiology
ISSN: 0160-9289
ISSN-E: 1932-8737
ISSN-L: 0160-9289
Volume: 43
Issue: 4
Pages: 401 - 409
DOI: 10.1002/clc.23329
Type of Publication: A1 Journal article – refereed
Field of Science: 3126 Surgery, anesthesiology, intensive care, radiology
Funding: This work was supported by The Finnish Medical Foundation, Helsinki, Finland; the Finnish Foundation for Cardiovascular Research, Helsinki, Finland; State Clinical Research Fund (EVO) of Turku University Hospital, Turku, Finland; by an unrestricted grant from Bristol‐Myers Squibb‐Pfizer; Emil Aaltonen Foundation, Helsinki, Finland; and Maud Kuistila Foundation, Helsinki, Finland.
Copyright information: © 2020 The Authors. Clinical Cardiology published by Wiley Periodicals, Inc. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.