title: Abnormal heart rate variability and atrial fibrillation after aortic surgery.
abstract: BACKGROUND
  Complete denervation of transplanted heart exerts protective effect against postoperative atrial fibrillation; various degrees of autonomic denervation appear also after transection of ascending aorta during surgery for aortic aneurysm.
  
  
  OBJECTIVE
  This study aimed to evaluate if the level of cardiac denervation obtained by resection of ascending aorta could exert any effect on postoperative atrial fibrillation incidence.
  
  
  METHODS
  We retrospectively analysed the clinical records of 67 patients submitted to graft replacement of ascending aorta (group A) and 132 with aortic valve replacement (group B); all episodes of postoperative atrial fibrillation occurred during the 1-month follow-up have been reported. Heart Rate Variability parameters were obtained from a 24-h Holter recording; clinical, echocardiographic and treatment data were also evaluated.
  
  
  RESULTS
  Overall, 45% of patients (group A 43%, group B 46%) presented at least one episode of postoperative atrial fibrillation. Older age (but not gender, abnormal glucose tolerance, ejection fraction, left atrial diameter) was correlated with incidence of postoperative atrial fibrillation. Only among a subgroup of patients with aortic transection and signs of greater autonomic derangement (heart rate variability parameters below the median and mean heart rate over the 75th percentile), possibly indicating more profound autonomic denervation, a lower incidence of postoperative atrial fibrillation was observed (22% vs. 54%).
  
  
  CONCLUSIONS
  Transection of ascending aorta for repair of an aortic aneurysm did not confer any significant protective effect from postoperative atrial fibrillation in comparison to patients with intact ascending aorta. It could be speculated that a limited and heterogeneous cardiac denervation was produced by the intervention, creating an eletrophysiological substrate for the high incidence of postoperative atrial fibrillation observed.
authors: Inst. Codivilla-Putti, Cortina d'Ampezzo, Italy.
authors: Leonida
authors: L
authors: Compostella
authors: Inst. Codivilla-Putti, Cortina d'Ampezzo, Italy.
authors: Nicola
authors: N
authors: Russo
authors: Dpt Cardiac, Thoracic and Vascular Sciences, University of Padua, Padova, Italy.
authors: Augusto
authors: A
authors: D'Onofrio
authors: Inst. Codivilla-Putti, Cortina d'Ampezzo, Italy.
authors: Tiziana
authors: T
authors: Setzu
authors: Dpt Medicine, School of Emergency Medicine, University of Padua, Padova, Italy.
authors: Caterina
authors: C
authors: Compostella
authors: Dpt Cardiac, Thoracic and Vascular Sciences, University of Padua, Padova, Italy.
authors: Tomaso
authors: T
authors: Bottio
authors: Dpt Cardiac, Thoracic and Vascular Sciences, University of Padua, Padova, Italy.
authors: Gino
authors: G
authors: Gerosa
authors: Inst. Codivilla-Putti, Cortina d'Ampezzo, Italy.
authors: Fabio
authors: F
authors: Bellotto
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001011:Aorta / Q000601:surgery; D001014:Aortic Aneurysm / Q000601:surgery*; D001021:Aortic Valve / Q000601:surgery; D001281:Atrial Fibrillation / Q000209:etiology* / Q000503:physiopathology; D001341:Autonomic Nervous System / Q000503:physiopathology; D005260:Female; D006321:Heart / Q000294:innervation*; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009121:Muscle Denervation; D011183:Postoperative Complications / Q000209:etiology*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome