Atrial fibrillation after surgical correction of mitral regurgitation in sinus rhythm: incidence, outcome, and determinants.
BACKGROUND
The incidence, determinants, and outcome of postoperative atrial fibrillation (AF) after surgery for mitral regurgitation (MR) are poorly defined but may have important implications for timing of mitral valve surgery.


RESULTS
In 762 patients in sinus rhythm with no AF history undergoing MR surgical correction, we examined the rates and prognostic implications of postoperative AF for early AF (within 2 weeks postoperatively) and late AF (>2 weeks after surgery). During postoperative follow-up, 180 patients (24%) experienced new AF (early AF in 136 and late AF in 111). Isolated early AF without recurrence was observed in 69 patients characterized by high angina class and lower left ventricular ejection fraction but no significant left atrial (LA) enlargement. However, overall early AF predicted late AF: 62+/-5% of patients with early AF had late AF at 10 years compared with 9+/-1% of patients without early AF (P<0.0001). Large LA size strongly and independently predicted early AF (P=0.01) and late AF (P=0.003). For late AF, the predictive value of an enlarged LA was cumulative to that of early AF. Postoperative AF was associated with an increased subsequently higher risk of stroke or congestive heart failure (adjusted risk ratio=1.46 [1.04 to 2.05], P=0.03).


CONCLUSIONS
Postoperative AF is common after surgical correction of MR in patients with no prior history of AF and is associated with increased subsequent morbidity. LA enlargement is independently predictive of postoperative AF and as such, should be integrated into the clinical decision-making process in patients with MR.
Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minn 55905, USA.
Steven J
SJ
Kernis
Vuyisile T
VT
Nkomo
David
D
Messika-Zeitoun
Bernard J
BJ
Gersh
Thoralf M
TM
Sundt
Karla V
KV
Ballman
Christopher G
CG
Scott
Hartzell V
HV
Schaff
Maurice
M
Enriquez-Sarano
D000368:Aged; D000369:Aged, 80 and over; D000787:Angina Pectoris / Q000453:epidemiology; D001281:Atrial Fibrillation / Q000453:epidemiology / Q000209:etiology*; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000473:pathology; D006333:Heart Failure / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D006984:Hypertrophy; D015994:Incidence; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D011237:Predictive Value of Tests; D011379:Prognosis; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology / Q000209:etiology; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome