Study shows postoperative atrial fibrillation tied to worse outcomes after valve surgery

Postoperative atrial fibrillation (POAF) is associated with an increased rate of neurologic events and worse long-term survival, according to a study published online Sept. 11 in the Journal of Thoracic and Cardiovascular Surgery.

Whitney Fu, M.D., from the University of Michigan in Ann Arbor, and colleagues examined the rate of POAF, incidence of neurologic events, development of permanent atrial fibrillation, and mortality in patients undergoing isolated mitral valve surgery. Analysis included 922 adult patients from 2011 to 2022 with no preoperative history of arrhythmias.

The researchers found that over a median follow-up of 4.9 months, the incidence of POAF was 39 percent. Risk factors for POAF included diabetes (odds ratio [OR], 2.2; 95 percent confidence interval [CI], 1.2 to 4.1; P = 0.01) and increasing age (OR, 1.1; 95 percent CI, 1.0 to 1.1; P < 0.001). New York Heart Association functional class was not a risk factor.

There was an association between POAF and development of permanent atrial fibrillation (OR, 3.2; 95 percent CI, 1.9 to 5.4; P < 0.001), which was associated with increased risk of neurologic events (OR, 3.8; 95 percent CI, 1.5 to 9.7; P = 0.004). Patients with POAF had worse unadjusted and adjusted long-term mortality (hazard ratio, 1.8; 95 percent CI, 1.1 to 3.1; P = 0.03).

"POAF is not benign and carries a long-term mortality implication," the authors write.