AF after mitral valve surgery “has a strong negative influence on survival”

The occurrence of atrial fibrillation (AF) after mitral valve surgery may be more harmful than previously thought, the authors of a research paper in the Journal of Thoracic and Cardiovascular Surgery (JCTVS) have stated.

Whitney Fu (University of Michigan Health Frankel Cardiovascular Center, Ann Arbor, USA) et al studied 922 adult patients with no preoperative history of arrhythmias who had mitral valve surgery between 2011 to 2022, examining rates of postoperative AF, incidence of neurologic events, development of permanent AF and mortality

The authors of the paper found in total that 39% of patients had postoperative AF after surgery, and almost one-quarter of those patients developed new or recurrent AF after 30 days. Almost 5% of patients with postoperative AF experienced a neurologic event, such as stroke, the researchers report.

“Our results suggest that postoperative atrial fibrillation is more harmful that people once thought,” said Fu. “We are seeing a strong negative influence of post-op AF on survival that is consistent with past research and suggests little improvement in addressing the issue.”

AF after heart valve surgery was also an independent risk factor for worse long-term survival among patients who had mitral valve surgery, according to the research.

“This high rate of AF after valve surgery and its potential severe downstream outcomes should encourage more research into the cause and prevention of postoperative AF, as well as the development of guidelines to manage the condition,” said the paper’s senior author, the cardiac surgeon Steven F Bolling (University of Michigan Health Frankel Cardiovascular Center, Ann Arbor, USA).

The researchers concluded that postoperative AF is associated with an increased rate of neurologic events, portends development of permanent AF, and is associated with worse long-term survival. “Postoperative AF is not benign and carries a long-term mortality implication,” the paper states.