University of Oulu

Rikhard Björn, Maunu Nissinen, Joonas Lehto, Markus Malmberg, Fredrik Yannopoulos, K.E. Juhani Airaksinen, Juha E.K. Hartikainen, Tuomo Nieminen, Fausto Biancari, Jarmo Gunn, Tuomas O. Kiviniemi, Late incidence and recurrence of new-onset atrial fibrillation after isolated surgical aortic valve replacement, The Journal of Thoracic and Cardiovascular Surgery, Volume 164, Issue 6, 2022, Pages 1833-1843.e4, ISSN 0022-5223,

Late incidence and recurrence of new-onset atrial fibrillation after isolated surgical aortic valve replacement

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Author: Björn, Rikhard1; Nissinen, Maunu2; Lehto, Joonas1;
Organizations: 1Heart Center, Turku University Hospital and University of Turku, Turku, Finland
2Heart Center, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
3Department of Surgery, Oulu University Hospital and University of Oulu, Oulu, Finland
4Department of Internal Medicine, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
5Department of Internal Medicine, South Karelia Central Hospital, Lappeenranta, Finland
6Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 1 MB)
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Language: English
Published: Elsevier, 2022
Publish Date: 2023-07-07


Objectives: Atrial fibrillation (AF) is a common complication after cardiac surgery. More knowledge is needed about long-term AF recurrence and adverse outcomes related to new-onset AF (NOAF) during the index hospitalization.

Methods: A total of 1073 patients underwent isolated surgical aortic valve replacement at the 4 participating hospitals (2002-2014). After the exclusion of patients with a history of any preoperative AF, the final study population included 529 patients in the bioprosthetic and 253 patients in the mechanical valve prosthesis cohort. Median follow-up time was 5.4 (interquartile range, 3.4-8.2) years in the combined cohort.

Results: Altogether 333 (42.6%) patients had in-hospital NOAF and 250 (32.0%) AF after hospital discharge. In the mechanical cohort, 64 (25.3%) experienced in-hospital NOAF and 74 (29.2%) AF after hospital discharge, whereas in the bioprosthetic cohort, 269 (50.9%) patients had in-hospital NOAF and 176 (33.3%) AF after hospital discharge. Patients with NOAF during the index hospital stay had a multifold risk of AF after hospital discharge in the combined cohort (hazard ratio [HR], 3.68; 95% confidence interval [CI], 2.82-4.81; P < .0001) as well as in both cohorts separately (bioprosthetic: HR, 4.35; 95% CI, 3.05-6.22; P < .001; mechanical: HR, 2.54; 95% CI, 1.59-4.03; P < .001). Patients with an in-hospital NOAF also had a significantly higher adjusted risk of death during the follow-up in the mechanical (HR, 2.05; 95% CI, 1.10-3.82; P = .025) and bioprosthetic (HR, 1.63; 95% CI, 1.17-2.28; P = .004) valve prosthesis cohorts.

Conclusions: NOAF during the index hospitalization is associated with a 2- to 4-fold risk of later AF and 1.6- to 2.0-fold risk of all-cause mortality after mechanical and bioprosthetic surgical aortic valve replacement.

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Series: Journal of thoracic and cardiovascular surgery
ISSN: 0022-5223
ISSN-E: 1097-685X
ISSN-L: 0022-5223
Volume: 164
Issue: 6
Pages: 1833 - 1843.e4
DOI: 10.1016/j.jtcvs.2021.03.101
Type of Publication: A1 Journal article – refereed
Field of Science: 3121 General medicine, internal medicine and other clinical medicine
Funding: Funding for this work was received from 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; and an unrestricted grant from Bristol-Myers-Squibb-Pfizer.
Copyright information: © 2021 The Authors. Published by Elsevier Inc. on behalf of The American Association for Pediatric Ophthalmology and Strabismus. This is an open access article under the CC BY license (