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Tummala et al. Vessel Plus 2022;6:17 Vessel Plus
DOI: 10.20517/2574-1209.2021.114

Review Open Access

Pre-operative and post-operative atrial fibrillation in

patients undergoing SAVR/TAVR

2
1
1
2,#
2
Vineet Tummala , Annet Kuruvilla , Ashutosh Yaligar , Sohaib Agha , Thomas Bilfinger , A. Laurie
Shroyer 2,#
1
Department of Medicine, Stony Brook University Renaissance School of Medicine, New York, NY 11794-8434, USA.
2
Department of Surgery, Stony Brook University Renaissance School of Medicine, New York, NY 11794-8434, USA.
#
Considered as senior authors.
Correspondence to: Prof. A. Laurie Shroyer, Department of Surgery, Stony Brook University Renaissance School of Medicine,
Health Science Center 19-080, 100 Nicolls Road, Stony Brook, New York, NY 11794-8434, USA.
E-mail: AnnieLaurie.Shroyer@stonybrookmedicine.edu
How to cite this article: Tummala V, Kuruvilla A, Yaligar A, Agha S, Bilfinger T, Shroyer AL. Pre-operative and post-operative
atrial fibrillation in patients undergoing SAVR/TAVR. Vessel Plus 2022;6:17. https://dx.doi.org/10.20517/2574-1209.2021.114
Received: 19 Aug 2021 First Decision: 1 Sep 2021 Revised: 15 Sep 2021 Accepted: 23 Sep 2021 Published: 5 Mar 2022

Academic Editor: Frank W. Sellke Copy Editor: Xi-Jun Chen Production Editor: Xi-Jun Chen

Abstract
Atrial fibrillation (AF) is a common preoperative comorbidity and post-operative complication associated with
cardiac surgery and is recognized as a significant predictor of adverse clinical outcomes. This review aims to
highlight the current literature regarding the incidence, risk factors, and outcomes of atrial fibrillation in patients
undergoing surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR)
procedures. A literature search of relevant articles was conducted via PubMed, Medline, and EMBASE. Pre-existing
AF is seen in 6.3%-35.2% of SAVR patients and 15.7%-48.9% of TAVR patients and is associated with increased
risk of mortality (OR = 2.2) and stroke (OR = 5.9). Postoperative AF (POAF) is more common after SAVR and in
patients with hemodynamic instability. The rates for POAF range from 11.1%-84% following SAVR and range from
3.0%-55.6% following TAVR. In-hospital mortality (7.8% vs. 3.4%; P < 0.01) and stroke (4.7% vs. 2.0%; P < 0.01)
are higher in the POAF group. POAF can be prevented via prophylactic antiarrhythmic medications and atrial
pacing. Therapeutic anticoagulation is recommended as it reduces the risk of thrombotic complications following
SAVR and TAVR procedures in the setting of POAF. Compared to those not on anticoagulant therapies, patients on
anticoagulation have decreased rates of stroke (1.7% vs. 5.5%) and fewer 30-day thrombotic complications (3% vs.
40%). These preventive measures are essential as POAF is associated with more thromboembolic events, longer
hospital stays, and higher overall morbidity and mortality rates.

© The Author(s) 2022. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, sharing,
adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as
long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and
indicate if changes were made.

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