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
. 2025 Aug 9;20(1):328.
doi: 10.1186/s13019-025-03577-6.

Predictive factors and pharmacological preventive interventions for atrial fibrillation after aortic valve replacement

Lu Chen  1 , Yu Liu  2 , Junmei Ge  2
Affiliations

Predictive factors and pharmacological preventive interventions for atrial fibrillation after aortic valve replacement

Lu Chen et al. J Cardiothorac Surg. .

Abstract

Objective: This study aims to investigate the predictive factors for postoperative atrial fibrillation (POAF) following aortic valve replacement (AVR) and evaluate the preventive effect of combined atorvastatin and metoprolol therapy on POAF.

Methods: This study employed a mixed design of retrospective cohort analysis and prospective randomized controlled trial, including 268 patients who underwent isolated AVR from January 1, 2022, to March 31, 2024. The 168 patients from January 1, 2022, to May 31, 2023, were analyzed for POAF predictive factors, while 100 patients from June 1, 2023, were included in the prospective trial. The intervention group (n = 50) received combined atorvastatin and metoprolol treatment starting 7 days before surgery.

Results: Multivariate logistic regression analysis identified age (OR = 1.12, 95% CI: 1.04–1.20, p = 0.003), history of stroke (OR = 10.94, 95% CI: 1.32–90.66, p = 0.027), EuroSCORE II (OR = 2.90, 95% CI: 1.61–5.20, p < 0.001), NT-proBNP level (OR = 1.002, 95% CI: 1.001–1.004, p = 0.009), hs-CRP level (OR = 1.55, 95% CI: 1.16–2.07, p = 0.003), and operation time (OR = 1.02, 95% CI: 1.01–1.04, p = 0.008) as independent predictors of POAF. Pharmacological intervention significantly reduced POAF incidence (p = 0.005) and shortened hospital stay (p < 0.001), ICU stay (p = 0.002), and mechanical ventilation time (p < 0.001). The AUC of the predictive model was 0.952, with a calibrated C-statistic of 0.904. Decision curve analysis demonstrated significant clinical utility across multiple risk thresholds.

Conclusion: Age, history of stroke, EuroSCORE II, NT-proBNP and hs-CRP levels, and operation time are independent predictors of POAF. Combined preventive treatment with atorvastatin and metoprolol reduced POAF incidence and postoperative hospital stay, showing promising clinical application prospects.

Keywords: Atorvastatin; Metoprolol; Pharmacological prevention; Postoperative atrial fibrillation after aortic valve replacement; Predictive factors.

PubMed Disclaimer

Conflict of interest statement

Declarations. Ethical statement: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
ROC curve
Fig. 2
Fig. 2
Calibration curve
Fig. 3
Fig. 3
Decision curve analysis (DCA)
Fig. 4
Fig. 4
Nomogram prediction model
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Siontis G, Overtchouk P, Cahill T, Modine T, Prendergast B, Praz F, et al. Transcatheter aortic valve implantation vs. surgical aortic valve replacement for treatment of symptomatic severe aortic stenosis: an updated meta-analysis. Eur Heart J. 2019;40(38):3143–53. 10.1093/eurheartj/ehz275 - PubMed
    1. Rezk M, Taha A, Nielsen S, Martinsson A, Bergfeldt L, Gudbjartsson T, et al. Associations between new-onset postoperative atrial fibrillation and long-term outcome in patients undergoing surgical aortic valve replacement. Eur J Cardiothorac Surg. 2023;63(5). 10.1093/ejcts/ezad015 - PMC - PubMed
    1. Tummala V, Kuruvilla A, Yaligar A, Agha S, Bilfinger T, Shroyer A. Pre-operative and post-operative atrial fibrillation in patients undergoing SAVR/TAVR. Vessel Plus. 2022;6:16. 10.20517/2574-1209.2021.93
    1. Shahim B, Malaisrie S, George I, Thourani V, Biviano A, Russo M, et al. Postoperative atrial fibrillation or flutter following transcatheter or surgical aortic valve replacement: PARTNER 3 trial. JACC Cardiovasc Interv. 2021;14(14):1565–74. 10.1016/j.jcin.2021.05.017 - PubMed
    1. Lo J, Crawford J, Desmond D, Bae H, Lim J, Godefroy O, et al. Long-term cognitive decline after stroke: an individual participant data meta-analysis. Stroke. 2022;53(5):1318–27. 10.1161/STROKEAHA.121.036501 - PubMed

LinkOut - more resources