Thromboembolisms related to post-operative electrical cardioversions for atrial fibrillation in patients with surgical aortic valve replacement
| Autor: | Fredrik Yannopoulos, Juha Hartikainen, Tuomo Nieminen, Fausto Biancari, Otto von Hellens, Joonas Lehto, Maunu Nissinen, Teemu Riekkinen, K.E.J. Airaksinen, Leo Ihlberg, Markus Malmberg, Tuomas Kiviniemi |
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| Rok vydání: | 2017 |
| Předmět: |
Adult
Male medicine.medical_specialty medicine.medical_treatment Population Electric Countershock Heart Valve Diseases 030204 cardiovascular system & hematology Transient ischaemic attacks Cardioversion 03 medical and health sciences Electrocardiography 0302 clinical medicine Postoperative Complications Aortic valve replacement Interquartile range Internal medicine Thromboembolism Atrial Fibrillation medicine Humans Sinus rhythm 030212 general & internal medicine education Finland Aged Aged 80 and over Bioprosthesis education.field_of_study business.industry Health Policy Incidence Atrial fibrillation ta3121 Middle Aged medicine.disease 3. Good health Survival Rate Aortic Valve Cardiology Female Cardiology and Cardiovascular Medicine business Cardioversions |
| Zdroj: | European heart journal. Quality of careclinical outcomes. 4(2) |
| ISSN: | 2058-1742 |
| Popis: | Aims Post-operative atrial fibrillation (POAF) is a frequent complication after open-heart surgery, and cardioversions (CV) are commonly performed to restore sinus rhythm. However, little data exists on thrombo-embolic risk related to early post-operative CV and on the recurrence of POAF after CV. CAREAVR study sought to assess the rate of strokes, transient ischaemic attacks (TIA), and mortality shortly after POAF-triggered CV in patients who underwent isolated surgical aortic valve replacement (SAVR) with a bioprosthesis. Methods and results Altogether 721 patients underwent isolated SAVR with a bioprosthesis at four Finnish university hospitals. During post-operative hospitalization, after patients with prior chronic AF were excluded, 309/634 (48.7%) of patients had at least one episode of POAF [median time (interquartile range) 3 (3) days], and an electrical CV was performed in 113/309 (36.6%) of them. The length of hospital stay was not affected by CV. At 30 days follow-up, the rate of stroke, TIA or mortality was higher in those AF patients who underwent CV vs. those who did not (9.7% vs. 3.6%, P = 0.04, respectively; adjusted hazard ratio 2.63, 95% confidence interval 1.00-6.92, P = 0.05). Similar proportion of patients in both groups were in AF rhythm at discharge (32.7% vs. 35.7%, P = 0.18); and at 3 months (25.0% vs. 23.6%, P = 0.40), respectively. Conclusion In this real-world population of patients undergoing isolated SAVR, the rate of POAF was nearly 50%. One-third of these patients underwent an electrical CV, and they exhibited over two-fold risk for thromboembolisms and mortality. Cardioversion did not affect the short-term prevalence of AF. |
| Databáze: | OpenAIRE |
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