Prediction of paroxysmal atrial fibrillation after aortic valve replacement in patients with aortic stenosis: identification of potential risk factors.
OBJECTIVE
Paroxysmal atrial fibrillation (AF) is a frequent complication after cardiac surgery. The study aim was to identify preoperative predictors of risk for this condition in patients with aortic stenosis after aortic valve replacement.


METHODS
The influence of clinical, echocardiographic and 24 h electrocardiogram (ECG) parameters on episodes of paroxysmal AF after aortic valve replacement (AVR) in 423 patients (156 women, 267 men; mean age 58 +/- 10 years) with aortic stenosis was analyzed. Episodes of postoperative paroxysmal AF were noted in 120 patients (28%).


RESULTS
Univariate analyses identified the following variables as risk factors for arrhythmia: age, NYHA functional class, history of preoperative paroxysmal AF, left ventricular mass index, >300 supraventricular beats on 24h ECG before surgery, presence of supraventricular tachycardia (SVT), SVT of >5 beats or with a rate >120 beats/min. Concomitant coronary artery bypass (CABG) grafting and presence of enlarged left atrium had no impact. By multivariate analysis, four variables were identified as independent predictors: age (odds ratio 1.7; 95% CI 1.2-2.1); history of paroxysmal AF (OR 3.2; CI 1.4-7.3); presence of >300 supraventricular beats/24 h (OR 1.9; CI 1.1-3.4); and presence of SVT (OR 2.1; CI 1.3-3.4). Discriminatory analysis revealed that a model comprising these four parameters enabled risk prediction in 68% of patients.


CONCLUSIONS
In patients with isolated aortic stenosis, age, past history of paroxysmal AF episodes, >300 supraventricular beats/24 h and presence of SVT during 24 h before AVR were predictors of postoperative paroxysmal AF episodes. Left atrial diameter and simultaneous CABG during AVR did not influence the likelihood of postoperative paroxysmal AF.
Orlowska-Baranowska
Ewa
E
Institute of Cardiology, Warsaw, Poland.
Baranowski
Rafa
R
Michalek
Piotr
P
Hoffman
Piotr
P
Rywik
Tomasz
T
Rawczylska-Englert
Irena
I
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000453:epidemiology / Q000601:surgery*; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D018880:Atrial Premature Complexes / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D001026:Coronary Artery Bypass; D004452:Echocardiography; D015716:Electrocardiography, Ambulatory; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging / Q000473:pathology; D006339:Heart Rate / Q000502:physiology; D019918:Heart Valve Prosthesis Implantation; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors; D012720:Severity of Illness Index; D013318:Stroke Volume / Q000502:physiology; D016896:Treatment Outcome