Ducceschi V, D'Andrea A, Galderisi M, De Feo M, Limongelli G, Mercurio B, Sarubbi B, Caso P, Cerasuolo F, Cotrufo M
Department of Cardiothoracic and Respiratory Sciences, Second University of Naples, Italy.
Ital Heart J. 2001 Jul;2(7):507-12.
Atrial fibrillation (AF) is the most frequently encountered arrhythmic complication associated with cardiac surgery. The aim of this paper was to identify the clinical predictors of AF occurrence following aortic valve replacement.
Three hundred and two patients were included in this study and divided into two groups according to the absence (SR group, 243 patients, mean age 55.6 +/- 15 years) or the evidence (AF group, 59 patients, mean age 63.8 +/- 11 years) of post-aortic valve replacement AF. Sixty-five perioperative variables (37 preoperative, 8 intraoperative and 20 postoperative) were considered.
Post-aortic valve replacement paroxysmal AF occurred in 59 out of 302 patients (19%). At univariate analysis, post-aortic valve replacement AF was associated with advanced age, left atrial enlargement, preoperative episodes of paroxysmal AF, the use of a warm blood cardioplegic solution and normothermia, administration of inotropic agents, prolonged assisted ventilation but also with postoperative acidosis, electrolyte imbalance and atrioventricular and intraventricular conduction disorders. Stepwise forward multivariate logistic regression analysis identified age (p = 0.002, odds ratio--OR 1.04), left atrial enlargement (p = 0.004, OR 2.6), a prior history of paroxysmal AF (p = 0.0003, OR 10.9), and postoperative electrolyte imbalance (p = 0.01, OR 2.3) as independent correlates of AF, whereas the use of hypothermia appeared to be a protective factor (p = 0.0004, OR 0.26).
According to our findings, post-aortic valve replacement AF seems to be associated with well-defined anatomical and electrical substrates generated by advanced age, increased left atrial dimensions, and a possible electrical remodeling consequent to prior repetitive episodes of paroxysmal AF. On these grounds, external factors such as postoperative electrolyte imbalance might enhance atrial ectopic activity and trigger postoperative sustained tachyarrhythmias, while the use of hypothermia might allow for better protection of the atrial myocardium against intraoperative ischemia.
心房颤动（AF）是心脏手术中最常见的心律失常并发症。本文旨在确定主动脉瓣置换术后房颤发生的临床预测因素。
本研究纳入302例患者，根据主动脉瓣置换术后是否发生房颤（窦性心律组，243例患者，平均年龄55.6±15岁；房颤组，59例患者，平均年龄63.8±11岁）分为两组。考虑了65个围手术期变量（37个术前变量、8个术中变量和20个术后变量）。
302例患者中有59例（19%）发生主动脉瓣置换术后阵发性房颤。单因素分析显示，主动脉瓣置换术后房颤与高龄、左心房扩大、术前阵发性房颤发作、使用温血心脏停搏液和常温、使用正性肌力药物、延长辅助通气时间有关，还与术后酸中毒、电解质失衡以及房室和室内传导障碍有关。逐步向前多因素逻辑回归分析确定年龄（p = 0.002，比值比-OR 1.04）、左心房扩大（p = 0.004，OR 2.6）、阵发性房颤病史（p = 0.0003，OR 10.9）和术后电解质失衡（p = 0.01，OR 2.3）是房颤的独立相关因素，而使用低温似乎是一个保护因素（p = 0.0004，OR 0.26）。
根据我们的研究结果，主动脉瓣置换术后房颤似乎与由高龄、左心房尺寸增加以及先前阵发性房颤反复发作导致的可能的电重构所产生的明确解剖和电基质有关。基于这些原因，术后电解质失衡等外部因素可能会增强心房异位活动并引发术后持续性快速心律失常，而使用低温可能会更好地保护心房心肌免受术中缺血的影响。
