Left heart remodeling as a risk factor for atrial fibrillation in patients after surgery of acquired heart defects

Abstract

Aim. To identify risk factors for atrial fibrillation (AF) in patients with aortic and mitral defects after surgical treatment.Material and methods. A total of 112 patients with aortic and mitral defects (excluding patients with mitral stenosis) were examined: 90 men and 22 women aged 18 to 72 years (median age, 51(35;57) years). Patients were examined initially before and after surgery (in terms of 8-14 days and after 12-36 months). The peak left atrial (LA) longitudinal strain (PALS) was determined at LA reservoir phase. The following endpoints were chosen: the presence of AF and atrial flutter (AFL) in the shortand long-term period after surgery, repeated hospitalization for arrhythmias. Patients were divided into 2 groups: group 1 — patients with a favorable prognosis, group 2 — patients with AF and AFL after surgery. The mean values were compared by the independent Student’s t test, while the rank sum — by the Mann-Whitney test. ROC analysis was used.Results. Baseline LA volume index (LAVI) >44,4 ml/m2 increased the risk of AF after surgery (AUC=0,6±0,07, p<0,05, relative risk (RR) — 2,34 (confidence interval (CI), 0,8-6,88). LA volumes were within the normal range in the group without arrhythmias. A decrease in the initial threshold level of LA PALS <27,5% increased the risk of AF as in the shortand long-term postoperative period (AUC=0,659±0,08, p<0,01, RR — 1,19 (CI, 3,38-31,4). In the AF group, PALS decreased after surgery and did not increase in the long-term period (28±7,5% at baseline, 19±6,2% after surgery, 21±8,3% in the long-term period, (p=0,04 and p=0, 23, respectively). Left ventricular ejection fraction affected the AF development only in the early period after surgery (AUC=0,71±0,049, p<0,008, RR — 2,21 (CI, 1,27-3,87).Conclusion. The development of AF was influenced by LAVI, LA PALS, while in the early postoperative surgery period — ejection fraction.