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
