Abstract
Objective: The incidence of new onset arrhythmia after conventional aortic valve replacement (AVR) is relatively high whereby atrial fibrillation (AF) in particular (30-40%). Arrhythmias increase postoperative morbidity, mortality and consequently health costs. The need for a reliable method for early detection and discrimination between low and high risk patients is therefore indispensable. For this reason this study examined the possible correlation between electrophysiological abnormalities on continuous ECG recordings and the initiation of arrhythmia directly after surgery. Methods and Results: Both ECG and clinical data was collected from the hospitals filing system for all patient (n=107) who underwent surgical Aortic Valve Replacement (AVR) for non-rheumatic aortic valve stenosis or insufficiency for the period from January 2010 to December 2018. Continuous ECG data was converted into ISHNE-format and analyzed by using Synescope™ software. Data showed that one minute prior to arrhythmia, AF in particular, an increase of both supraventricular premature beats (SVPB) and missed beats (MB) was detected (n=33; P<0,05). However there was no correlation between arrhythmia and the overall SVPB incidence (n=33). Twenty-one out of 33 AVR patients developed a de novo intraventricular conductance delay directly after cardioplegic arrest, which persisted in 7 cases. Conclusions: Although there is an increase of both SVPB and MB prior to arrhythmia startup, it is still questionable what is the true predictive value of these findings are. Additionally it appeared that a temporarily intraventricular conduction delay (IVCD) is a common finding after AVR.
Highlights
Aortic valve stenosis is the most common form of valvular heart disease
The need for a reliable method for early detection and discrimination between low and high risk patients is indispensable. For this reason this study examined the possible correlation between electrophysiological abnormalities on continuous ECG recordings and the initiation of arrhythmia directly after surgery
Aortic valve replacement (AVR) improves the quality of life and prolongs its expectancy, valve replacement is known to be associated with severe peri- and postoperative complications like bleeding and infection [2, 3]
Summary
Aortic valve stenosis is the most common form of valvular heart disease. Aortic valve replacement (AVR) is a frequently performed procedure [1]. AVR improves the quality of life and prolongs its expectancy, valve replacement is known to be associated with severe peri- and postoperative complications like bleeding and infection [2, 3]. The most common post-AVR complications are cardiac arrhythmias with an incidence rate of over 70%. These arrhythmias are mainly originating in the supraventricular compartments, whereby newonset atrial fibrillation (AF) has by far the highest incidence (30-40%) [3, 4, 5]. Patients developing supra ventricular arrhythmias are at significantly higher risk to experience additional co-morbidity such as congestive heart failure and thromboembolic events, including stroke and PBMJ Vol. Issue 2 Jul-Dec 2021
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