Rizza Vincenzo, Maranta Francesco, Cianfanelli Lorenzo, Cartella Iside, Maisano Francesco, Alfieri Ottavio, Cianflone Domenico
Vita-Salute San Raffaele University Milan Italy.
Cardiac Rehabilitation Unit IRCCS San Raffaele Scientific Institute Milan Italy.
J Arrhythm. 2023 Nov 27;40(1):67-75. doi: 10.1002/joa3.12956. eCollection 2024 Feb.
Postoperative atrial fibrillation (POAF) is the most common arrhythmia following cardiac surgery (CS). It may occur between the 1st and the 4th postoperative day as acute POAF or between the 5th and the 30th as subacute (sPOAF). sPOAF is associated with higher thromboembolic risk, which consistently increase patients' morbidity. Neutrophil-to-lymphocyte ratio (NLR) is a low-cost inflammatory index proposed as possible POAF predictor. Identification of patients' risk categories might lead to improved postoperative outcomes.
The aim was to assess the incidence of sPOAF and to identify possible predictors in patients performing cardiovascular rehabilitation (CR) after CS. A single-center cohort study was performed on 737 post-surgical patients admitted to CR on sinus rhythm. Continuous monitoring with 12-lead ECG telemetry was performed. We evaluated the predictive role of anamnestic, clinical, and laboratory data, including baseline NLR.
Subacute POAF was documented in 170 cases (23.1%). At the multivariate analysis, age (OR 1.03; = .001), mitral valve surgery (OR 1.77; = .012), acute POAF (OR 2.97; < .001), and NLR at baseline (OR 1.13; = .042) were found to be independent predictive factors of sPOAF following heart surgery.
sPOAF is common after CS. Age, mitral valve procedures, acute POAF, and preoperative NLR were proved to increase sPOAF occurrence in CR. NLR is an affordable and reliable parameter which might be used to qualify the risk of arrhythmias at CR admission. Identification of new predictors of postoperative atrial fibrillation may allow to improve patients' prognosis.
术后心房颤动（POAF）是心脏手术（CS）后最常见的心律失常。它可能在术后第1天至第4天以急性POAF的形式出现，或在第5天至第30天以亚急性（sPOAF）的形式出现。sPOAF与较高的血栓栓塞风险相关，这持续增加患者的发病率。中性粒细胞与淋巴细胞比率（NLR）是一种低成本的炎症指标，被提议作为可能的POAF预测指标。识别患者的风险类别可能会改善术后结局。
目的是评估sPOAF的发生率，并识别CS后进行心脏康复（CR）的患者中可能的预测因素。对737例接受CR且窦性心律的术后患者进行了单中心队列研究。采用12导联心电图遥测进行连续监测。我们评估了病史、临床和实验室数据（包括基线NLR）的预测作用。
记录到170例（23.1%）亚急性POAF。在多变量分析中，年龄（比值比1.03；P = 0.001）、二尖瓣手术（比值比1.77；P = 0.012）、急性POAF（比值比2.97；P < 0.001）和基线NLR（比值比1.13；P = 0.042）被发现是心脏手术后sPOAF的独立预测因素。
CS后sPOAF很常见。年龄、二尖瓣手术、急性POAF和术前NLR被证明会增加CR中sPOAF的发生率。NLR是一个经济且可靠的参数，可用于在CR入院时评估心律失常的风险。识别术后心房颤动的新预测因素可能有助于改善患者的预后。
