Leiler Spela, Bauer Andre, Hitzl Wolfgang, Bernik Rok, Guenzler Valentin, Angerer Matthias, Fischlein Theodor, Kalisnik Jurij Matija
Department of Cardiac Surgery, Nuremberg Clinic, Paracelsus Medical University, Nuremberg, Germany.
Campus Nuremberg, Paracelsus Medical University, Nuremberg, Germany.
Interdiscip Cardiovasc Thorac Surg. 2025 Mar 29;40(4). doi: 10.1093/icvts/ivae178.
Atrial fibrillation is a common complication after heart surgery, potentially leading to chronic atrial fibrillation, heart failure and mortality. The aim of this study was to explore the relationship between preoperative interatrial block and the occurrence of postoperative atrial fibrillation.
Perioperative 12-channel electrocardiographies of patients in sinus rhythm scheduled for heart surgery, including bypass and/or valve surgery, were analysed. Patients with pre-existing atrial fibrillation, amiodarone therapy, atrioventricular block II or III, or pacemaker were excluded from the study. Clinical parameters in patients with versus without atrial fibrillation were compared. To evaluate the association between interatrial block and postoperative atrial fibrillation, univariable and multivariable regression analyses were performed.
Out of 2374 patients, 1350 were amenable to analysis. Postoperative atrial fibrillation was documented in 505 (37.4%) patients. In multivariable regression analysis, prediction models with and without interatrial block were established. Step-wise regression analysis identified interatrial block [2.64 (2.02; 3.46), P < 0.001), age [1.11 (1.03; 1.20), P = 0.007], EuroScore II [1.05 (1.03; 1.07), P < 0.001], pulmonary hypertension [1.91 (1.24; 2.97), P = 0.006], history of cardiogenic shock [2.05 (1.11; 3.87), P = 0.032], statins [1.66 (1.21; 2.27), P = 0.002], chronic obstructive pulmonary disease [2.11 (1.25; 3.65), P = 0.009] and cardiopulmonary bypass time [1.78 (1.04; 3.05), P = 0.047] as independent predictors for postoperative atrial fibrillation.
Preoperative interatrial block was associated with a higher incidence of postoperative atrial fibrillation. Inclusion of electrocardiography-derived preoperative conduction disturbances can enhance risk stratification of postoperative atrial fibrillation after heart surgery.
心房颤动是心脏手术后常见的并发症，可能导致慢性心房颤动、心力衰竭和死亡。本研究旨在探讨术前房间阻滞与术后心房颤动发生之间的关系。
对计划进行心脏手术（包括搭桥和/或瓣膜手术）且处于窦性心律的患者的围手术期12导联心电图进行分析。已存在心房颤动、接受胺碘酮治疗、存在二度或三度房室阻滞或有起搏器的患者被排除在研究之外。比较发生心房颤动和未发生心房颤动患者的临床参数。为评估房间阻滞与术后心房颤动之间的关联，进行了单变量和多变量回归分析。
在2374例患者中，1350例适合进行分析。505例（37.4%）患者记录到术后心房颤动。在多变量回归分析中，建立了包含和不包含房间阻滞的预测模型。逐步回归分析确定房间阻滞[2.64（2.02；3.46），P＜0.001]、年龄[1.11（1.03；1.20），P = 0.007]、欧洲心脏手术风险评估系统II[1.05（1.03；1.07），P＜0.001]、肺动脉高压[1.91（1.24；2.97），P = 0.006]、心源性休克病史[2.05（1.11；3.87），P = 0.032]、他汀类药物[1.66（1.21；2.27），P = 0.002]、慢性阻塞性肺疾病[2.11（1.25；3.65），P = 0.009]和体外循环时间[1.78（1.04；3.05），P = 0.047]为术后心房颤动的独立预测因素。
术前房间阻滞与术后心房颤动的较高发生率相关。纳入术前心电图得出的传导障碍可增强心脏手术后术后心房颤动的风险分层。
