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Thorac Cardiovasc Surg
DOI: 10.1055/a-2722-4150
Original Cardiovascular

Postoperative Atrial Fibrillation after aortic valve replacement: An Isolated Episode?

Authors

  • Laura Varela Barca 

    1   Cardiac surgery, Hospital Universitario de la Princesa, Madrid, Spain (Ringgold ID: RIN16517)

  • Nieves De Antonio Antón

    1   Cardiac surgery, Hospital Universitario de la Princesa, Madrid, Spain (Ringgold ID: RIN16517)

  • Hugo Auquilla Luzuriaga

    1   Cardiac surgery, Hospital Universitario de la Princesa, Madrid, Spain (Ringgold ID: RIN16517)

  • Esperanza Gomez Alonso

    1   Cardiac surgery, Hospital Universitario de la Princesa, Madrid, Spain (Ringgold ID: RIN16517)

  • Maria Roldan Martinez

    2   Universidad Autónoma de Madrid, Madrid, Spain (Ringgold ID: RIN16722)

  • Emilio Monguió Santín

    1   Cardiac surgery, Hospital Universitario de la Princesa, Madrid, Spain (Ringgold ID: RIN16517)

  • Fernando Alfonso Manterola

    3   Cardiology, Hospital Universitario de la Princesa, Madrid, Spain (Ringgold ID: RIN16517)

  • Guillermo Reyes Copa

    1   Cardiac surgery, Hospital Universitario de la Princesa, Madrid, Spain (Ringgold ID: RIN16517)
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Objectives: Postoperative atrial fibrillation (POAF) is a frequent entity after cardiac surgery. However, its potential relationship with adverse outcomes and permanent arrhythmias remains uncertain. We sought to assess the relationship between the occurrence of atrial fibrillation (AF) in the postoperative period and its long-term recurrence. Methods: Patients who underwent aortic valve replacement (AVR) with a biological prosthesis between 2005 and 2023 were analyzed. The incidence of atrial fibrillation in the postoperative period and the factors associated with its occurrence, as well as its long-term recurrence and related risk factors were analyzed. Results: The incidence of POAF was 22%. Postoperative renal insufficiency (p<0.001) and chronic obstructive pulmonary disease (COPD) (p=0.047) were identified as risk factors. During long-term clinical follow-up (mean 6.5±4.5 years), 20.4% of patients without any previous arrhythmia episodes developed AF, whereas the incidence was 40.4% in those with atrial fibrillation in the postoperative period [Hazard Ratio (HR)=2.18 (1.33-3.56); p=0.002]. AF during follow-up was independently associated with age (HR=1.05), COPD (HR=3.22), and POAF (HR=1.9). In addition, there was an apparent association between permanent AF during follow-up and long-term mortality, which approached statistical significance [HR=1.4 (95% CI: 0.9-1.8); p=0.06]. Conclusions: POAF is a frequent complication following AVR and is significantly associated with an increased risk of developing permanent AF during long-term follow-up. Multivariate analysis identified renal insufficiency and COPD as independent predictors of POAF, while age and COPD were independently associated with long-term AF. Additionally, there was a trend toward an association between permanent AF and increased long-term mortality



Publication History

Received: 08 July 2025

Accepted after revision: 01 October 2025

Accepted Manuscript online:
14 October 2025

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