Key result
Preoperative AF in severe AS links to ~30% larger left atrial volume and post-AVR recurrence.
Why the study?
The mechanism underlying atrial fibrillation in patients with severe aortic stenosis is unclear, and factors associated with new-onset AF after aortic valve replacement need investigation.
What echocardiographic factors are associated with the development of new-onset atrial fibrillation after aortic valve replacement in patients with severe aortic stenosis?
Cohort (n=125)
What echocardiographic factors are associated with the development of new-onset atrial fibrillation after aortic valve replacement in patients with severe aortic stenosis?
In patients with severe aortic stenosis undergoing aortic valve replacement, a restrictive filling pattern and elevated systolic blood pressure are independent predictors of new-onset postoperative atrial fibrillation.
Answers are grounded in this paper and cite their sources.
Restrictive filling may flag higher postoperative AF risk after AVR; hypothesis-generating and requires prospective validation.
Atrial fibrillation (AF) is common in patients with aortic stenosis (AS) although the exact mechanism is unclear. The purpose of this study was to investigate echocardiographic characteristics among patients with severe AS and AF and to identify factors associated with the development of new-onset AF after aortic valve replacement (AVR). 125 patients with severe AS and ejection fraction > 40% scheduled for AVR were evaluated preoperatively and 3, 6, 9 and 12 months postoperatively with electrocardiography (ECG) and echocardiography, and Holter-ECG analysis was performed after 3 and 12 months. The primary endpoint was new-onset AF defined as an episode of AF exceeding 30 s, on the ECG or Holter-ECG and/or patients hospitalized due to AF. AF was present in 19 patients prior to AVR, compared to patients in sinus rhythm AF patients had increased NT-proBNP, increased left atrial (LA) volume (61 ± 21 vs. 47 ± 17 ml/m2, p = 0.002), reduced global longitudinal left ventricular strain (− 13.1 ± 3.7 vs. − 16.0 ± 3.5, p = 0.002) and presented more often with a restrictive filling pattern (37% vs. 10%, p = 0.002). During follow-up 23 patients developed new-onset AF; predictors were LA volume, restrictive filling pattern, NT-proBNP, E/e′ and systolic blood pressure. After correcting for age and LA volume index, a restrictive filling pattern and systolic blood pressure remained associated with new-onset AF. The presence of preoperative AF and development of new-onset AF after AVR is associated with restrictive filling pattern and LA dilatation in patients with severe AS.
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Dahl et al. (2014) conducted a cohort in Severe aortic valve stenosis (n=125). Echocardiographic characteristics (restrictive filling pattern, left atrial volume) vs. Absence of these characteristics was evaluated on New-onset AF defined as an episode of AF exceeding 30 s, on the ECG or Holter-ECG and/or patients hospitalized due to AF. Preoperative AF in severe aortic stenosis was associated with increased left atrial volume (61 vs 47 ml/m2, p=0.002) and a restrictive filling pattern (37% vs 10%, p=0.002), which also predicted new-onset AF after valve replacement.
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