Clinical correlates of atrial tachyarrhythmias after valve replacement for aortic stenosis.
One hundred eighteen consecutive patients undergoing valve replacement for aortic stenosis were analyzed to determine the incidence of and predisposing factors to postoperative atrial tachyarrhythmias. Univariate and multivariate analyses were performed on 70 clinical, hemodynamic, radiographic, electrocardiographic, operative, and postoperative variables. Forty-seven patients (40%) experienced atrial tachyarrhythmias at a median of 3 days after surgery (70% atrial fibrillation, 22% atrial flutter, and 6% junctional tachycardia). Preoperative descriptors associated with an increased prevalence of atrial tachyarrhythmias were age 70 years or older (p less than .02), mitral regurgitation (p less than .002), history of paroxysmal atrial fibrillation (p less than .03), or antiarrhythmic therapy (p less than .006), diabetes mellitus (p less than .01), and elevated pulmonary systolic, mean, and capillary wedge pressures (p less than .02, p less than .007, p less than .005). Postoperative descriptors were prolonged respirator therapy (p less than .001), use of catecholamines (p less than .01) or vasodilators (p less than .05), and prolonged stay in the intensive care unit (p less than .04). Multivariate analysis of these 12 variables showed advanced age, diabetes mellitus, and prolonged respirator use to be independently associated with atrial tachycardias and to predict them with a sensitivity of 62% and a specificity of 77%. Anticipation of atrial arrhythmias in patients with specific clinical descriptors may be used to guide prophylactic therapy.
Douglas, PS; Hirshfeld, JW; Edmunds, LH
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