Methods

The influence of clinical, echocardiographic and 24 h electrocardiogram (ECG) parameters on episodes of paroxysmal AF after aortic valve replacement (AVR) in 423 patients (156 women, 267 men; mean age 58+/-10 years) with aortic stenosis was analyzed. Episodes of postoperative paroxysmal AF were noted in 120 patients (28%).

Results

Univariate analyses identified the following variables as risk factors for arrhythmia: age, NYHA functional class, history of preoperative paroxysmal AF, left ventricular mass index,> 300 supraventricular beats on 24h ECG before surgery, presence of supraventricular tachycardia (SVT), SVT of> 5 beats or with a rate> 120 beats/min. Concomitant coronary artery bypass (CABG) grafting and presence of enlarged left atrium had no impact. By multivariate analysis, four variables were identified as independent predictors: age (odds ratio 1.7; 95% CI 1.2-2.1); history of paroxysmal AF (OR 3.2; CI 1.4-7.3); presence of> 300 supraventricular beats/24 h (OR 1.9; CI 1.1-3.4); and presence of SVT (OR 2.1; CI 1.3-3.4). Discriminatory analysis revealed that a model comprising these four parameters enabled risk prediction in 68% of patients.

Conclusion

In patients with isolated aortic stenosis, age, past history of paroxysmal AF episodes,> 300 supraventricular beats/24 h and presence of SVT during 24 h before AVR were predictors of postoperative paroxysmal AF episodes. Left atrial diameter and simultaneous CABG during AVR did not influence the likelihood of postoperative paroxysmal AF.