Department of Cardiac Surgery, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China.
Clin Cardiol. 2021 Oct;44(10):1432-1439. doi: 10.1002/clc.23703. Epub 2021 Aug 14.
The impact of new-onset atrial fibrillation (AF) after aortic valve (AV) surgery on mid- and long-term outcomes is under debate. Here, we sought to follow up heart rhythms after AV surgery, and to evaluate the mid-term prognosis and effectiveness of treatment for patients with new-onset AF.
This single-center cohort study included 978 consecutive patients (median age, 59 years; male, 68.5%) who underwent surgical AV procedures between 2017 and 2018. All patients with postoperative new-onset AF were treated with Class III antiarrhythmic drugs with or without electrical cardioversion (rhythm control). Status of survival, stroke, and rhythm outcomes were collected and compared between patients with and without new-onset AF.
New-onset AF was detected in 256 (26.2%) patients. For them, postoperative survival was comparable with those without new-onset AF (1-year: 96.1% vs. 99.3%; adjusted P = .30), but rate of stroke was significantly higher (1-year: 4.0% vs. 2.2%; adjusted P = .020). With rhythm control management, the 3-month and 1-year rates of paroxysmal or persistent AF between patients with and without new-onset AF were 5.1% versus 1.3% and 7.5% versus 2.1%, respectively (both P < .001). Multivariate models showed that advanced age, impaired ejection fraction, new-onset AF and discontinuation of beta-blockers were predictors of AF at 1 year.
In most cases, new-onset AF after AV surgery could be effectively converted and suppressed by rhythm control therapy. Nevertheless, new-onset AF predisposed patients to higher risks of stroke and AF within 1 year, for whom prophylactic procedures and continuous beta-blockers could be beneficial.
主动脉瓣（AV）手术后新发心房颤动（AF）对中、长期预后的影响仍存在争议。在此，我们旨在随访 AV 手术后的心律情况，并评估新发 AF 患者的中期预后和治疗效果。
这项单中心队列研究纳入了 2017 年至 2018 年期间接受 AV 手术的 978 例连续患者（中位年龄 59 岁，男性占 68.5%）。所有术后新发 AF 患者均采用 III 类抗心律失常药物联合或不联合电复律（节律控制）进行治疗。收集并比较了新发 AF 患者与无新发 AF 患者的生存、卒中和心律结局。
256 例（26.2%）患者检出新发 AF。对于这些患者，术后生存率与无新发 AF 患者相当（1 年：96.1% vs. 99.3%；调整 P=0.30），但卒中发生率显著升高（1 年：4.0% vs. 2.2%；调整 P=0.020）。通过节律控制管理，新发 AF 患者与无新发 AF 患者的阵发性或持续性 AF 在 3 个月和 1 年时的发生率分别为 5.1%比 1.3%和 7.5%比 2.1%（均 P<0.001）。多变量模型显示，高龄、射血分数降低、新发 AF 和停用β受体阻滞剂是 1 年后发生 AF 的预测因素。
在大多数情况下，AV 手术后新发 AF 可通过节律控制治疗有效转复和抑制。然而，新发 AF 使患者在 1 年内发生卒中及 AF 的风险增加，对于此类患者，预防性治疗和持续使用β受体阻滞剂可能有益。
