Preoperative risk factors for atrial fibrillation and assessment of the likelihood of its occurrence in the early postoperative period after correction of severe aortic stenosis based on ultrasound examination

The aim of the study: To determine the risk factors and likelihood of developing postoperative atrial fibrillation (POAF) after aortic valve replacement (AVR) for severe aortic stenosis (AS). Materials and methods. A multicenter retrospective-prospective study was conducted among 181 patients with severe AS who underwent isolated valve replacement using biological prostheses in 2019–2025. The subjects were divided into two groups: with postoperative AF (POAF) (n = 75) and a group without POAF (n = 106). The median age was 72 [67, 75] and 70 [67, 73] years (p = 0.206), respectively. Female gender was 49 (65.3%), 62 (58.5%) (p = 0.438). Results. Risk factors for AF development in the early postoperative period were assessed using multivariate analysis. Statistically significant factors included: left ventricular diastolic dysfunction (LVDD) grade 2 (β = 0.90, p = 0.020, OR 2.5 (1.2–5.4)) and grade 3 (β = 1.4, p = 0.006, OR 4.0 (1.5–11.0)), presence of rhythm disturbances in the anamnesis before surgery (β = 4.04, p < 0.001, OR 57 (7–67)), and replacement of the aortic valve using implanted bioprostheses (β = 0.90, p = 0.028, 2.5 (1.1–5.6)). For further analysis of risk factors and calculation of the probability of occurrence of postoperative AF, the group including patients with POAF was divided into two subgroups: individuals with the presence of cardiac arrhythmia in the anamnesis before surgery (n = 32), and without arrhythmia in the anamnesis in the preoperative period (n = 43). In the group of patients with no preoperative cardiac arrhythmia, the presence of grade 2 LVDD, grade 3 LVDD before surgery, a biological suture prosthesis, and female gender were statistically significant risk factors for developing POAF. In the group with in the anamnesis preoperative cardiac arrhythmia, there were no other statistically significant risk factors for developing POAF, and the odds of developing POAF increased 57-fold at baseline. If a patient had grade 3 LVDD at baseline and a biological suture prosthesis was used, the risk of developing POAF increased regardless of gender. Conclusion. Preoperative risk factors for the development of AF in the early postoperative period in individuals who underwent surgical correction of severe AS and did not have cardiac arrhythmia preoperatively were: LVDD grades 2 and 3, female gender, and bioprosthetics using implanted prostheses. The presence of paroxysmal AF or frequent atrial extrasystoles before surgery is the main risk factor for the development of POAF. The likelihood of developing AF in the early postoperative period after coronary artery bypass graft replacement for severe AS significantly increases in the presence of the above-mentioned risk factors.