Department of Cardiology, All India Institute of Medical Sciences (AIIMS), New Delhi, India.
National Institute of Pathology, Indian Council of Medical Research (ICMR), Safdarjung Hospital Campus, New Delhi, India.
J Interv Card Electrophysiol. 2022 Sep;64(3):621-628. doi: 10.1007/s10840-021-01085-w. Epub 2021 Nov 8.
Late-onset atrial fibrillation (LOAF) after valve surgery for degenerative mitral valve disease often with underlying mitral valve prolapse is a known phenomenon. However, there is no similar data for postoperative rheumatic heart disease (RHD) patients. We sought to assess the incidence and predictors of LOAF during postoperative follow-up in RHD patients.
This single-center retrospective case-control study included a total of 384 RHD patients with normal sinus rhythm (NSR) who underwent rheumatic valve surgery between 1st July 2008 and 30th June 2013. Patients detected with de novo persistent atrial fibrillation (AF) after 2 months of valve surgery were diagnosed as having LOAF. Presurgical demographic and echocardiographic parameters were compared between the LOAF and NSR groups to identify risk factors for LOAF.
The incidence of de novo LOAF after rheumatic valve surgery was 9.63% at an average of 2.67 ± 1.32 years follow-up. Age ≥ 32 years [OR 2.4 (95% CI 1.2-5.1); P = 0.01] and left atrial (LA) size ≥ 51 mm [OR 5.9 (95% CI 2.8-12.4); P < 0.0001] were the most significant and independent predictors of LOAF. Moreover, significant mitral valve disease was associated with a higher risk of LOAF than significant aortic valve disease (P = 0.037). LA size ≥ 51 mm at surgery showed a fair discriminative power [AUC = 0.75; sensitivity = 68%, specificity = 70%] to identify patients at high risk for LOAF.
Late-onset AF develops in almost a tenth of the RHD patients postoperatively following corrective valve surgery. Preoperative LA size can be used to identify patients at high risk for LOAF.
退行性二尖瓣疾病（二尖瓣脱垂）患者在瓣膜手术后出现的晚发性心房颤动（LOAF）是一种已知现象。然而，对于风湿性心脏病（RHD）患者术后出现类似情况的报道却很少。我们试图评估 RHD 患者术后随访中 LOAF 的发生率和预测因素。
这项单中心回顾性病例对照研究共纳入了 384 名窦性心律（NSR）的 RHD 患者，他们于 2008 年 7 月 1 日至 2013 年 6 月 30 日期间接受了风湿性瓣膜手术。术后 2 个月新诊断出持续性心房颤动（AF）的患者被诊断为 LOAF。比较 LOAF 组和 NSR 组之间术前的人口统计学和超声心动图参数，以确定 LOAF 的危险因素。
风湿性瓣膜手术后新发 LOAF 的发生率为 9.63%，平均随访时间为 2.67±1.32 年。年龄≥32 岁[比值比（OR）2.4（95%置信区间 1.2-5.1）；P=0.01]和左心房（LA）大小≥51mm[OR 5.9（95%置信区间 2.8-12.4）；P<0.0001]是 LOAF 的最显著和独立预测因素。此外，与主动脉瓣病变相比，二尖瓣病变与 LOAF 的风险更高相关（P=0.037）。手术时 LA 大小≥51mm 对 LOAF 高危患者的识别具有良好的判别能力[AUC=0.75；敏感性=68%，特异性=70%]。
风湿性心脏病患者在接受瓣膜矫正手术后，近十分之一的患者会发生晚发性心房颤动。术前 LA 大小可用于识别 LOAF 高危患者。
