title: Atrial fibrillation at mid-term after bioprosthetic aortic valve replacement – implications for anti-thrombotic therapy.
abstract: BACKGROUND
  Little is known about mid-term (3-month) postoperative atrial fibrillation (MT-POAF) in patients treated with bioprosthetic aortic valve replacement (BAVR). The aim of this study was to describe the natural history, identify the predictors and investigate the potential consequences in terms of anti-thrombotic therapy.
  
  
  RESULTS
  During a longitudinal, prospective study, 219 patients were treated with BAVR early (7 days) and at mid-term postoperatively (30 and 90 days). POAF was monitored and risk factors were identified on logistic regression analysis. History of previous AF (OR, 3.08; 95% CI: 1.35-6.98), early POAF (OR, 5.93; 95% CI: 2.96-11.8), and BMI (per 5 kg/m(2): OR, 1.46; 95% CI: 1.03-2.09), were independent predictors for MT-POAF whereas sex, age and Euroscore were not. Results were identical when restricted to the 176 patients free from preoperative AF. In this subgroup, 36 patients (20.4%) had MT-POAF; 33 out of 174 (18.7%) would have required anticoagulation (CHA2DS2VASc score ≥ 1). Conversely, patients with BMI <27.7 and sinus rhythm at early follow-up had a very low risk of MT-POAF (OR, 0.16; 95% CI: 0.06-0.42).
  
  
  CONCLUSIONS
  There was a higher than expected occurrence of MT-POAF in patients treated with BAVR, particularly in overweight patients with early POAF. This raises the question of implementing an anti-thrombotic therapy in these patients at higher risk of delayed atrial arrhythmia.
authors.affiliation: Medical Sciences Department, University of Torino.
authors.forename: Francesco
authors.initials: F
authors.lastname: Tosello
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Florens
authors.forename: Thibault
authors.initials: T
authors.lastname: Caruba
authors.forename: Christine
authors.initials: C
authors.lastname: Lebeller
authors.forename: Lea
authors.initials: L
authors.lastname: Mimoun
authors.forename: Alberto
authors.initials: A
authors.lastname: Milan
authors.forename: Jean-Noel
authors.initials: JN
authors.lastname: Fabiani
authors.forename: Pierre
authors.initials: P
authors.lastname: Boutouyrie
authors.forename: Philippe
authors.initials: P
authors.lastname: Menasché
authors.forename: Agnès
authors.initials: A
authors.lastname: Lillo-Lelouet
mesh_terms: D050154:Adiposity; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001281:Atrial Fibrillation / Q000453:epidemiology / Q000209:etiology*; D001705:Bioprosthesis; D015992:Body Mass Index; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D008297:Male; D009765:Obesity / Q000150:complications; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D011184:Postoperative Period; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors; D012720:Severity of Illness Index; D012907:Smoking / Q000453:epidemiology; D013923:Thromboembolism / Q000453:epidemiology / Q000209:etiology; D019851:Thrombophilia / Q000453:epidemiology / Q000209:etiology
chemical_list: D005343:Fibrinolytic Agents