Incidence, etiology, and outcomes of pre- and post-operative atrial fibrillation in mitral valve procedures: a review

Abstract

Although pre-procedural and post-procedural atrial fibrillation occur commonly in mitral valve (MV) patients, the impact on patient outcomes and resource utilization has not been well documented. A comprehensive PubMed review was performed using a combination of MeSH terms related to atrial fibrillation, MV disease, MV and atrial fibrillation procedures, and medical management. Additional publications were selected from the reference lists of studies identified in the literature search. This review found that several studies conflict with the short-term outcomes associated with pre- and post-operative atrial fibrillation in MV patients. In general, both pre- and post-operative atrial fibrillation have clear negative long-term impacts on MV patients’ mortality and risk of stroke, major bleeding and other thromboembolic events. Surgical ablation for pre-operative atrial fibrillation and transcatheter ablation for medically resistant post-operative atrial fibrillation appears to be safe and effective procedure; these percutaneous and surgical interventions have been documented to mitigate MV-related thromboembolic risk. For MV patients, evidence suggests that the first step should be to optimize the current medical therapy; for persistent symptoms not addressed medically, ablation procedures should be considered. To optimize MV patients’ quality of care, however, additional research appears warranted to prevent long-term adverse outcomes.

Editorial review: guidance for future atrial fibrillation research

“…After risk adjustment, however, it was very interesting to learn that POAF was not associated with increased 10-year mortality. Furthermore, contrary to popular belief, using an off-pump (OPCAB) approach did not avert POAF or differentially impact the ROOBY POAF patients' risk-adjusted 10-year survival [11] . In addition, it confirmed previous knowledge that non-Maze surgical incisions into the atria neither encourage nor discourage POAF.…”

“…Quin et al utilized the VA Randomized On-/Off-Bypass (ROOBY) trial's database to evaluate the impact of post-CABG POAF on longer-term outcomes [11] . Based on historical VA findings [5] , it was not surprising to find that the ROOBY coronary artery bypass graft (CABG) survivors that initially had new-onset POAF complications also had higher AF rates at 10-year follow-up as compared to non-POAF patients.…”

“…Although CABG patients' POAF rates have been reportedly high [5,11] , Dokko's systematic review reported that the highest cardiac surgical post-procedural POAF rates have been found for mitral valve replacement or repair (MVR) procedures; moreover, the authors reported that very innovative technological advances have taken place [12] . For all MVR patients with preoperative AF and POAF, medical therapy should be evaluated as a treatment to avoid POAF.…”