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Thorac Cardiovasc Surg 2005; 53(1): 41-45
DOI: 10.1055/s-2004-830460
Original Cardiovascular

© Georg Thieme Verlag KG Stuttgart · New York

Atrial Fibrillation at Discharge From the Hospital in Patients Undergoing Mitral Valve Repair

A. Jovin1 , 3 , S. Hashim1 , I. S. Jovin2 , J. F. Clancy2 , W.-P. Klövekorn3 , G. Müller-Berghaus3
  • 1Yale-New Haven Hospital, New Haven, CT, USA
  • 2Yale University School of Medicine, New Haven, CT, USA
  • 3Kerckhoff Heart Center, Bad Nauheim, Germany
Further Information

Publication History

Received July 19, 2004

Publication Date:
03 February 2005 (online)

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Abstract

Background: Patients undergoing mitral valve repair (MVRr) are often discharged on oral anticoagulation with warfarin. Because the decision about oral anticoagulation is made at discharge from the hospital and because atrial fibrillation (AF) represents the only well-documented indication for oral anticoagulation in these patients, we studied the frequency of AF at discharge after MVRr. Methods: We reviewed the records of 245 patients who underwent MVRr over the past 5 years and assessed the frequency of AF at discharge from the hospital and the factors that were associated with an increased risk for arrhythmia. Results: The group comprised 95 women and 150 men with a mean age of 62.1 ± 14 years. Seventy-three (30 %) patients were in and/or had a history of AF on admission. Sixty-five (27 %) patients had AF at discharge. Factors that were associated with AF at discharge were: AF on admission (odds ratio [OR] 57.1; confidence interval [CI] 20.8 - 157.3; p < 0.0001), enlarged left atrium (OR 3.2; CI 1.2 - 8.7; p = 0.025) and intake of ACE inhibitors (OR 3.9; CI 1.2 - 12.3; p = 0.022). The OR for AF at discharge in patients with none of the above risk factors was 0.02 (95 % CI 0.02 - 0.13; p < 0.0001). Conclusion: Only a relatively small proportion of the studied patients, especially patients with AF on admission, with larger atria and with a history of ACE inhibitors intake, were in AF at discharge after MVRr. Patients with none of these risk factors were at low risk for AF at discharge after MVRr and the optimal oral anticoagulation regimen for these low-risk patients needs to be determined.

Key words

Mitral valve - atrial fibrillation - anticoagulants - risk factors - atrial enlargement - ACE inhibitors

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Angelika Jovin

Middlesex Hospital

90 South Main Street

Middletown, CT 06457

USA

Phone: 8603446469

Fax: 860 3 44 66 50

Email: ajovin@yahoo.com

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