title: New-onset postoperative atrial fibrillation after aortic valve replacement: Effect on long-term survival.
abstract: There is a paucity of data on long-term survival of new-onset postoperative atrial fibrillation (POAF) after cardiac surgery. Also, mean follow-up in previous studies is confined to a maximum of one decade. This retrospective, longitudinal cohort study was performed to determine the effect on long-term survival of new-onset POAF after aortic valve replacement (AVR) over a mean follow-up of almost 2 decades.
  
  
  
  Kaplan-Meier survival analysis was used to determine long-term survival after AVR, performed between January 1, 1990, and January 1, 1994, in 569 consecutive patients without a history of atrial fibrillation, divided into 241 patients (42.4%) with and 328 patients (57.6%) without new-onset POAF. New-onset POAF was considered in multivariable analysis for decreased long-term survival. After AVR, patients with new-onset POAF were treated with the aim to restore sinus rhythm within 24 to 48 hours from onset by medication and when medication failed by direct-current cardioversion before discharge home.
  
  
  
  Mean follow-up after AVR was 17.8 ± 1.9 years. Incidence of new-onset POAF was 42.4%. Kaplan-Meier overall cumulative survival rates at 15 years of follow-up were similar in the patients with new-onset POAF versus those without: 41.5% (95% confidence interval [CI], 35.2-47.7) versus 41.3% (95% CI, 36.0-46.7), respectively. New-onset POAF was not an independent risk factor for decreased long-term survival (hazard ratio 0.815; 95% CI, 0.663-1.001; P = .052).
  
  
  
  New-onset POAF after AVR does not affect long-term survival when treatment is aimed to restore sinus rhythm before discharge home.
authors.affiliation: Department of Cardiology, St Antonius Hospital, Nieuwegein, The Netherlands. Electronic address: b.m.swinkels@hetnet.nl.
authors.forename: Ben M
authors.initials: BM
authors.lastname: Swinkels
authors.affiliation: Department of Cardiothoracic Surgery, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Bas A
authors.initials: BA
authors.lastname: de Mol
authors.affiliation: Department of Cardiology, St Antonius Hospital, Nieuwegein, The Netherlands.
authors.forename: Johannes C
authors.initials: JC
authors.lastname: Kelder
authors.affiliation: Department of Cardiothoracic Surgery, St Antonius Hospital, Nieuwegein, The Netherlands.
authors.forename: Freddy E
authors.initials: FE
authors.lastname: Vermeulen
authors.affiliation: Department of Cardiology, St Antonius Hospital, Nieuwegein, The Netherlands.
authors.forename: Jurriën M
authors.initials: JM
authors.lastname: Ten Berg
mesh_terms: D000368:Aged; D001021:Aortic Valve / Q000601:surgery*; D001281:Atrial Fibrillation / Q000209:etiology* / Q000401:mortality; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology* / Q000401:mortality; D012189:Retrospective Studies; D016019:Survival Analysis
keywords: aortic valve replacement; atrial fibrillation; coronary artery bypass surgery; direct-current cardioversion; perioperative management; survival