Predictors of Late-Onset Atrial Fibrillation Following Isolated Mitral Valve Repairs in Patients With Preserved Ejection Fraction
J. Trent Magruder, Sarah Collica, Stephen Belmustakov, Todd C. Crawford, Joshua C. Grimm, Duke E. Cameron, William A. Baumgartner, Kaushik Mandal
Background: We sought to determine the incidence of and risk factors for late-onset atrial fibrillation (LOAF) in patients with preserved ejection fractions undergoing mitral valve repair. Methods: We included patients undergoing isolated mitral valve repair (MVR) for degenerative disease between 1997–2014 at our institution with EF ≥60%. Patients who had AF preoperatively were excluded from the final analysis. Our primary outcome, LOAF, was defined as AF occurring after discharge following MVR (≥9 days). Results: 223 patients were included in the study with a mean follow-up of 4.8 ± 4.6 years. A total of 25 patients developed LOAF, and freedom from LOAF was 93.9% at one year, and 87.3% at five years. Patients developing LOAF were of similar mean age (58 vs. 63 years in controls, p = 0.08) and had similar preoperative comorbidities, but did show a trend toward larger left atrial diameter (5.1 vs. 4.7 cm, p = 0.11). After risk adjustment with Cox regression analysis, only increasing left atrial size was associated with LOAF (HR 1.63, p = 0.04). On follow-up, 29 patients (10.8%) developed moderate or greater mitral regurgitation at a mean of 2.2 years. Using a mixed-effects model, we were unable to detect an association between recurrent mitral regurgitation following MVR and LOAF (OR 1.36, p = 0.42). Conclusions: LOAF occurs in about 13% of preserved ejection fraction patients undergoing MVR by five years. Increasing left atrial diameter is an independent predictor of LOAF. Concomitant anti-arrhythmic procedures may warrant further investigation in patients with preserved ejection fraction and enlarged left atria undergoing MVR. doi: 10.1111/jocs.12774 (J Card Surg 2016;31:486–492).
Journal of Cardiac Surgery
https://doi.org/10.1111/jocs.12774
10.1111/jocs.12774
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Mitral Valve Medicine & Life Sciences 100%
Atrial Fibrillation Medicine & Life Sciences 88%
Mitral Valve Insufficiency Medicine & Life Sciences 24%
Risk Adjustment Medicine & Life Sciences 14%
Anti-Arrhythmia Agents Medicine & Life Sciences 12%
Heart Atria Medicine & Life Sciences 11%
Regression Analysis Medicine & Life Sciences 7%
Incidence Medicine & Life Sciences 5%
Magruder, J. T., Collica, S., Belmustakov, S., Crawford, T. C., Grimm, J. C., Cameron, D. E., Baumgartner, W. A., & Mandal, K. (2016). Predictors of Late-Onset Atrial Fibrillation Following Isolated Mitral Valve Repairs in Patients With Preserved Ejection Fraction. Journal of Cardiac Surgery, 31(8), 486-492. https://doi.org/10.1111/jocs.12774
Magruder, J. Trent ; Collica, Sarah ; Belmustakov, Stephen ; Crawford, Todd C. ; Grimm, Joshua C. ; Cameron, Duke E. ; Baumgartner, William A. ; Mandal, Kaushik. / Predictors of Late-Onset Atrial Fibrillation Following Isolated Mitral Valve Repairs in Patients With Preserved Ejection Fraction. In: Journal of Cardiac Surgery. 2016 ; Vol. 31, No. 8. pp. 486-492.
@article{ae3dbb09aaec43f49253f88397ecb7e7,
title = "Predictors of Late-Onset Atrial Fibrillation Following Isolated Mitral Valve Repairs in Patients With Preserved Ejection Fraction",
abstract = "Background: We sought to determine the incidence of and risk factors for late-onset atrial fibrillation (LOAF) in patients with preserved ejection fractions undergoing mitral valve repair. Methods: We included patients undergoing isolated mitral valve repair (MVR) for degenerative disease between 1997–2014 at our institution with EF ≥60%. Patients who had AF preoperatively were excluded from the final analysis. Our primary outcome, LOAF, was defined as AF occurring after discharge following MVR (≥9 days). Results: 223 patients were included in the study with a mean follow-up of 4.8 ± 4.6 years. A total of 25 patients developed LOAF, and freedom from LOAF was 93.9% at one year, and 87.3% at five years. Patients developing LOAF were of similar mean age (58 vs. 63 years in controls, p = 0.08) and had similar preoperative comorbidities, but did show a trend toward larger left atrial diameter (5.1 vs. 4.7 cm, p = 0.11). After risk adjustment with Cox regression analysis, only increasing left atrial size was associated with LOAF (HR 1.63, p = 0.04). On follow-up, 29 patients (10.8%) developed moderate or greater mitral regurgitation at a mean of 2.2 years. Using a mixed-effects model, we were unable to detect an association between recurrent mitral regurgitation following MVR and LOAF (OR 1.36, p = 0.42). Conclusions: LOAF occurs in about 13% of preserved ejection fraction patients undergoing MVR by five years. Increasing left atrial diameter is an independent predictor of LOAF. Concomitant anti-arrhythmic procedures may warrant further investigation in patients with preserved ejection fraction and enlarged left atria undergoing MVR. doi: 10.1111/jocs.12774 (J Card Surg 2016;31:486–492).",
author = "Magruder, {J. Trent} and Sarah Collica and Stephen Belmustakov and Crawford, {Todd C.} and Grimm, {Joshua C.} and Cameron, {Duke E.} and Baumgartner, {William A.} and Kaushik Mandal",
note = "Publisher Copyright: {\textcopyright} 2016 Wiley Periodicals, Inc. Copyright: Copyright 2018 Elsevier B.V., All rights reserved.",
doi = "10.1111/jocs.12774",
journal = "Journal of Cardiac Surgery",
Magruder, JT, Collica, S, Belmustakov, S, Crawford, TC, Grimm, JC, Cameron, DE, Baumgartner, WA & Mandal, K 2016, 'Predictors of Late-Onset Atrial Fibrillation Following Isolated Mitral Valve Repairs in Patients With Preserved Ejection Fraction', Journal of Cardiac Surgery, vol. 31, no. 8, pp. 486-492. https://doi.org/10.1111/jocs.12774
Predictors of Late-Onset Atrial Fibrillation Following Isolated Mitral Valve Repairs in Patients With Preserved Ejection Fraction. / Magruder, J. Trent; Collica, Sarah; Belmustakov, Stephen; Crawford, Todd C.; Grimm, Joshua C.; Cameron, Duke E.; Baumgartner, William A.; Mandal, Kaushik.
In: Journal of Cardiac Surgery, Vol. 31, No. 8, 01.08.2016, p. 486-492.
T1 - Predictors of Late-Onset Atrial Fibrillation Following Isolated Mitral Valve Repairs in Patients With Preserved Ejection Fraction
AU - Magruder, J. Trent
AU - Collica, Sarah
AU - Belmustakov, Stephen
AU - Crawford, Todd C.
AU - Grimm, Joshua C.
AU - Cameron, Duke E.
AU - Baumgartner, William A.
AU - Mandal, Kaushik
N1 - Publisher Copyright: © 2016 Wiley Periodicals, Inc. Copyright: Copyright 2018 Elsevier B.V., All rights reserved.
N2 - Background: We sought to determine the incidence of and risk factors for late-onset atrial fibrillation (LOAF) in patients with preserved ejection fractions undergoing mitral valve repair. Methods: We included patients undergoing isolated mitral valve repair (MVR) for degenerative disease between 1997–2014 at our institution with EF ≥60%. Patients who had AF preoperatively were excluded from the final analysis. Our primary outcome, LOAF, was defined as AF occurring after discharge following MVR (≥9 days). Results: 223 patients were included in the study with a mean follow-up of 4.8 ± 4.6 years. A total of 25 patients developed LOAF, and freedom from LOAF was 93.9% at one year, and 87.3% at five years. Patients developing LOAF were of similar mean age (58 vs. 63 years in controls, p = 0.08) and had similar preoperative comorbidities, but did show a trend toward larger left atrial diameter (5.1 vs. 4.7 cm, p = 0.11). After risk adjustment with Cox regression analysis, only increasing left atrial size was associated with LOAF (HR 1.63, p = 0.04). On follow-up, 29 patients (10.8%) developed moderate or greater mitral regurgitation at a mean of 2.2 years. Using a mixed-effects model, we were unable to detect an association between recurrent mitral regurgitation following MVR and LOAF (OR 1.36, p = 0.42). Conclusions: LOAF occurs in about 13% of preserved ejection fraction patients undergoing MVR by five years. Increasing left atrial diameter is an independent predictor of LOAF. Concomitant anti-arrhythmic procedures may warrant further investigation in patients with preserved ejection fraction and enlarged left atria undergoing MVR. doi: 10.1111/jocs.12774 (J Card Surg 2016;31:486–492).
AB - Background: We sought to determine the incidence of and risk factors for late-onset atrial fibrillation (LOAF) in patients with preserved ejection fractions undergoing mitral valve repair. Methods: We included patients undergoing isolated mitral valve repair (MVR) for degenerative disease between 1997–2014 at our institution with EF ≥60%. Patients who had AF preoperatively were excluded from the final analysis. Our primary outcome, LOAF, was defined as AF occurring after discharge following MVR (≥9 days). Results: 223 patients were included in the study with a mean follow-up of 4.8 ± 4.6 years. A total of 25 patients developed LOAF, and freedom from LOAF was 93.9% at one year, and 87.3% at five years. Patients developing LOAF were of similar mean age (58 vs. 63 years in controls, p = 0.08) and had similar preoperative comorbidities, but did show a trend toward larger left atrial diameter (5.1 vs. 4.7 cm, p = 0.11). After risk adjustment with Cox regression analysis, only increasing left atrial size was associated with LOAF (HR 1.63, p = 0.04). On follow-up, 29 patients (10.8%) developed moderate or greater mitral regurgitation at a mean of 2.2 years. Using a mixed-effects model, we were unable to detect an association between recurrent mitral regurgitation following MVR and LOAF (OR 1.36, p = 0.42). Conclusions: LOAF occurs in about 13% of preserved ejection fraction patients undergoing MVR by five years. Increasing left atrial diameter is an independent predictor of LOAF. Concomitant anti-arrhythmic procedures may warrant further investigation in patients with preserved ejection fraction and enlarged left atria undergoing MVR. doi: 10.1111/jocs.12774 (J Card Surg 2016;31:486–492).
U2 - 10.1111/jocs.12774
DO - 10.1111/jocs.12774
JO - Journal of Cardiac Surgery
JF - Journal of Cardiac Surgery
Magruder JT, Collica S, Belmustakov S, Crawford TC, Grimm JC, Cameron DE et al. Predictors of Late-Onset Atrial Fibrillation Following Isolated Mitral Valve Repairs in Patients With Preserved Ejection Fraction. Journal of Cardiac Surgery. 2016 Aug 1;31(8):486-492. https://doi.org/10.1111/jocs.12774