Characterization of atrial arrhythmias following mitral valve repair: Incidence and risk factors

• Published in: Journal of cardiovascular electrophysiology 2024-10, Vol.35 (10), p.1972-1980
• Main Authors: el Mathari, Sulayman, Tomšič, Anton, Kharbanda, Rohit K., Zappala, Pietro, Wijnmaalen, Adrianus P., Klautz, Robert J. M., Silva, Marta de Riva, Palmen, Meindert
• Format: Article
• Language: English
• Subjects: Arrhythmia; atrial arrhythmia; atrial fibrillation; Cardiac arrhythmia; cardiac surgery; Mitral valve; mitral valve repair; Risk factors; Tachycardia
• ISSN: 1045-3873; 1540-8167; 1540-8167
• DOI: 10.1111/jce.16390

Objectives This study aims to investigate the occurrence, type and correlation of early and late atrial arrhythmias following mitral valve repair in patients with no preoperative history of atrial arrhythmias. Methods Patients undergoing mitral valve (MV) repair for degenerative disease were included. Early and late postoperative electrocardiograms were evaluated for the incidence and type of atrial arrhythmia (atrial fibrillation [AF] or atrial tachycardia [AT]). Results The 192 patients were included. Early atrial arrhythmias occurred in 100/192 (52.1%) patients; AF in 61 (31.8%) patients, early AT in 15 (7.8%) and both in 24 (12.5%). In total 89% of patients were discharged in sinus rhythm. During a follow‐up time of 7.3 years, 14 patients (7.3%) died and 49 (25.5%) patients developed late atrial arrhythmias. At 10 years, the cumulative incidence of any late atrial arrhythmia, with death as competing risk, was 64% (95% confidence interval [CI] = 55%–72%). On Fine‐Gray model analysis, only early postoperative AF lasting >24 h was related to the development of late AF (hazard ratio 5.99, 95% CI = 1.78%–20.10%, p = .004). Early postoperative ATs were related to the development of late tachycardias, independent of their duration (24 h hazard ratio 3.51, 95% CI = 1.65–7.46, p = .001). Conclusions Early and late atrial arrhythmias were common after MV repair surgery. Only early postoperative AF lasting >24 h was a risk factor for the occurrence of late AF. Conversely, any postoperative AT was correlated to the development of late ATs. Following surgical MV repair, early postoperative atrial arrhythmias carried a different prognosis in terms of clinical results and the risk of arrhythmia recurrence based on the type and duration of the postoperative arrhythmia.