Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Jun;19(6):394-400.
doi: 10.14744/AnatolJCardiol.2018.70745.

Postoperative atrial fibrillation prediction following isolated surgical aortic valve replacement

Alina Cristina Iliescu, Delia Lidia Salaru, Ionut Achitei, Mihaela Grecu, Mariana Floria  1 , Grigore Tinica
Affiliations

Postoperative atrial fibrillation prediction following isolated surgical aortic valve replacement

Alina Cristina Iliescu et al. Anatol J Cardiol. 2018 Jun.

Abstract

Objective: Postoperative atrial fibrillation (POAF) is the most common complication following cardiac surgery, with increased risk of stroke and high mortality. Our aim was to identify patients at risk and to design a model that could predict POAF.

Methods: In this single center study, we evaluated 1191 patients requiring isolated surgical aortic valve replacement between January 2000 and June 2014. The patients were followed during the early postoperative period until discharge.

Results: AF occurred in 342 patients (28.71%). Six variables associated with high arrhythmic risk [advanced age, body mass index, tricuspid regurgitation, prolonged ventilation, longer intensive care unit stay, and dilated left atrium (LA; volume ≥35 ml/m2)] were selected to create a multivariate prediction model. This model predicted POAF in 64.7% of cases, with a moderate discriminative power (AUC=0.65; p=0.001; 95% CI, 0.571-0.771). We also developed the CHAID (Chi-square automatic interaction detection) model showing multilevel interactions among risk factors for POAF. Age had the greatest discriminative power, with patients aged >68 years at a higher risk for POAF. In low-risk patients, the subgroup with dilated LA (volume ≥40 ml) was more prone to develop POAF. For the intermediate-risk group, history of AF was the next deciding variable, whereas for the high-risk group, it was tricuspid regurgitation (at least moderate).

Conclusion: The multivariate logistic model has an acceptable predictive value. CHAID-derived model is a new tool that could be easily applied to identify patients requiring prophylactic regimens.

PubMed Disclaimer

Conflict of interest statement

Conflict of interest: None declared.

Figures

Figure 1
Figure 1
Flow chart of patients with isolated aortic valve replacement included in the study
Figure 2
Figure 2
Receiver operator characteristic curve of point score as a predictor for new-onset postoperative atrial fibrillation in patients undergoing aortic surgery
Figure 3
Figure 3
Tree model based on Chi-squared automatic interaction detection for patients with postoperative atrial fibrillation. AF - atrial fibrillation; BMI - body mass index; LA vol - left atrial volume; TR - tricuspid regurgitation
See this image and copyright information in PMC

Comment in

  • Perioperative predictors of atrial fibrillation.
    İşcan Ş, Eygi B, Beşir Y, Gökalp O. İşcan Ş, et al. Anatol J Cardiol. 2018 Sep;20(3):194. doi: 10.14744/AnatolJCardiol.2018.34946. Anatol J Cardiol. 2018. PMID: 30152803 Free PMC article. No abstract available.

References

    1. Shrivastava R, Smith B, Caskey D, Reddy P. Atrial fibrillation after cardiac surgery:does prophylactic therapy decrease adverse outcomes associated with atrial fibrilation. J Intensive Care Med. 2009;24:18–25. - PubMed
    1. Mahoney EM, Thomson TD, Veledar E, Williams J, Weintraub WS. Cost-effectiveness of targeting patients undergoing cardiac surgery for therapy with intravenous amiodarone to prevent atrial fibrillation. J Am Coll Cardiol. 2002;40:737–45. - PubMed
    1. Aranki SF, Shaw DP, Adams DH, Rizzo RJ, Couper GS, VanderVliet M, et al. Predictors of atrial fibrillation after coronary artery surgery. Current trends and impact on hospital resources. Circulation. 1996;94:390–7. - PubMed
    1. Zaman AG, Archbold RA, Helft G, Paul EA, Curzen NP, Mills PG. Atrial fibrillation after coronary artery bypass surgery:a model for preoperative risk stratification. Circulation. 2000;101:1403–8. - PubMed
    1. Lomivorotov VV, Efremov SM, Pokushalov EA, Karaskov AM. New onset atrial fibrillation after cardiac surgery:pathophysiology, prophylaxis and treatment. J Cardiothorac Vasc Anesth. 2016;30:200–16. - PubMed