Prognostic value of the preoperative echocardiography indicators in the development of atrial fibrillation after aortic valve replacement

Annotation. Postoperative atrial fibrillation (POAF) is the most common and significant complication that occurs after various types of open heart surgery, in particular, in more than half of cases in patients after aortic valve replacement, which leads to an increase in morbidity, mortality, and length of stay hospitalization and financial costs. POAF can lead to the development of stroke, thromboembolism, cardiac arrest, and an increased risk of death. The issue of POAF occurrence predictors after aortic valve replacement have not been fully studied. The aim is to identify and analyze probable predictors of the POAF development in patients after aortic valve replacement based on the study of preoperative echocardiographic parameters. The study included 244 patients (158 men, 86 women) aged from 27 to 83 years (average - 60.94±10.92 years), who underwent aortic valve replacement. All of them were divided into two groups: group I consisted of 102 patients with AF that developed in the postoperative period, group II – 142 patients without POAF. A comparative assessment of demographic, general clinical, instrumental and electrophysiological indicators was conducted. POAF developed in 102 out of 244 patients after aortic valve replacement, which is 41.8% of patients in the first experimental group). By the ROC analysis, the cut-off levels of preoperative echocardiographic indicators for predicting the POAF development were calculated: the diameter of the left atrium (AUROC 0.594; 95% CI 0.52-0.67) at the optimal distribution point >4.55 cm has a sensitivity of 49 %, specificity 57.7%); left atrial volume (AUROC 0.673; 95% CI 0.6-0.74) at the cut-off level >87.5 cm3 – sensitivity 61.2%, specificity 60.9%; end-diastolic size of the left ventricle (AUROC 0.658; 95% CI 0.51-0.81) at the cut-off level >5.8 cm – sensitivity 67.7%, specificity 77.8%). Against the background of the conducted research, it was established that significant risk factors for postoperative atrial fibrillation in patients after aortic valve replacement are: bicuspid structure of the aortic valve, II-III stage of the mitral insufficiency, an increase of the left atrium diameter more than 4.55 cm, an increase of the left atrium volume more than 87.5 cm3 and the end-diastolic size of the left ventricle more than 5.8 cm. The revealed predictors of the POAF development will allow developing a prognostic model of risks, as well as an effective strategy for the prevention of rhythm disorders in this category patients.