Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands.
Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands.
J Cardiovasc Electrophysiol. 2024 Oct;35(10):1972-1980. doi: 10.1111/jce.16390. Epub 2024 Aug 8.
This study aims to investigate the occurrence, type and correlation of early and late atrial arrhythmias following mitral valve repair in patients with no preoperative history of atrial arrhythmias.
Patients undergoing mitral valve (MV) repair for degenerative disease were included. Early and late postoperative electrocardiograms were evaluated for the incidence and type of atrial arrhythmia (atrial fibrillation [AF] or atrial tachycardia [AT]).
The 192 patients were included. Early atrial arrhythmias occurred in 100/192 (52.1%) patients; AF in 61 (31.8%) patients, early AT in 15 (7.8%) and both in 24 (12.5%). In total 89% of patients were discharged in sinus rhythm. During a follow-up time of 7.3 years, 14 patients (7.3%) died and 49 (25.5%) patients developed late atrial arrhythmias. At 10 years, the cumulative incidence of any late atrial arrhythmia, with death as competing risk, was 64% (95% confidence interval [CI] = 55%-72%). On Fine-Gray model analysis, only early postoperative AF lasting >24 h was related to the development of late AF (hazard ratio 5.99, 95% CI = 1.78%-20.10%, p = .004). Early postoperative ATs were related to the development of late tachycardias, independent of their duration (<24 h hazard ratio 4.25, 95% CI = 1.89-9.57, p = .001 and >24 h hazard ratio 3.51, 95% CI = 1.65-7.46, p = .001).
Early and late atrial arrhythmias were common after MV repair surgery. Only early postoperative AF lasting >24 h was a risk factor for the occurrence of late AF. Conversely, any postoperative AT was correlated to the development of late ATs.
本研究旨在探讨无术前房性心律失常病史的二尖瓣修复术后早期和晚期房性心律失常的发生、类型和相关性。
纳入因退行性病变而行二尖瓣（MV）修复术的患者。评估术后早期和晚期心电图房性心律失常（心房颤动[AF]或房性心动过速[AT]）的发生率和类型。
共纳入 192 例患者。100/192（52.1%）例患者出现早期房性心律失常；AF 61 例（31.8%），早期 AT 15 例（7.8%），两者均有 24 例（12.5%）。总共 89%的患者出院时为窦性心律。在 7.3 年的随访期间，14 例（7.3%）患者死亡，49 例（25.5%）患者出现晚期房性心律失常。10 年时，任何晚期房性心律失常的累积发生率（以死亡为竞争风险）为 64%（95%置信区间[CI] = 55%-72%）。在 Fine-Gray 模型分析中，只有持续时间>24 h 的术后早期 AF 与晚期 AF 的发生相关（风险比 5.99，95%CI = 1.78%-20.10%，p = .004）。早期术后 AT 与晚期心动过速的发生相关，与持续时间无关（<24 h 的风险比 4.25，95%CI = 1.89-9.57，p = .001 和>24 h 的风险比 3.51，95%CI = 1.65-7.46，p = .001）。
二尖瓣修复术后早期和晚期房性心律失常很常见。只有持续时间>24 h 的术后早期 AF 是发生晚期 AF 的危险因素。相反，任何术后 AT 均与晚期 AT 的发生相关。
