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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   Department of Cardiac Surgery, Hospital Universitario de la Princesa, Madrid, Spain

  • Nieves De Antonio Antón

    1   Department of Cardiac Surgery, Hospital Universitario de la Princesa, Madrid, Spain

  • Hugo Auquilla Luzuriaga

    1   Department of Cardiac Surgery, Hospital Universitario de la Princesa, Madrid, Spain

  • Esperanza Gomez Alonso

    1   Department of Cardiac Surgery, Hospital Universitario de la Princesa, Madrid, Spain

  • Maria Roldan Martinez

    2   Cardiac Surgery, Universidad Autónoma de Madrid, Madrid, Spain

  • Emilio Monguió Santín

    1   Department of Cardiac Surgery, Hospital Universitario de la Princesa, Madrid, Spain

  • Fernando Alfonso Manterola

    3   Department of Cardiology, Hospital Universitario de la Princesa, Madrid, Spain

  • Guillermo Reyes Copa

    1   Department of Cardiac Surgery, Hospital Universitario de la Princesa, Madrid, Spain
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Abstract

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 at our center. 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).

Conclusion

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.

Keywords

atrial fibrillation - cardiac surgery - long-term outcomes

Data Availability Statement

The data underlying this study will be shared on reasonable request to the corresponding author.




Publikationsverlauf

Eingereicht: 08. Juli 2025

Angenommen: 01. Oktober 2025

Accepted Manuscript online:
14. Oktober 2025

Artikel online veröffentlicht:
28. Oktober 2025

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