Analysis of risk factors for arrhythmia in patients after heart valve replacement_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

YAN Manrong ,  ZHONG Qianjin , GOU Yongchao , CHEN Jianming , HU Yijie , SONG Yi , YUAN Ye

Department of Cardiovascular Surgery, Daping Hospital, Army Medical University, Chongqing, 400042, P.R.China;

Corresponding author：

ZHONG Qianjin, Email: zhongqianjin@qq.corn

Keywords：

Valve replacement; arrhythmia; atrial fibrillation; risk factors

DOI：

10.7507/1007-4848.202004072

Video：

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Objective To explore and analyze the risk factors for arrhythmia in patients after heart valve replacement.Methods A retrospective analysis of 213 patients undergoing cardiac valve replacement surgery under cardiopulmonary bypass in our hospital from August 2017 to August 2019 was performed, including 97 males and 116 females, with an average age of 53.4±10.5 year and cardiac function classification (NYHA) grade of Ⅱ-Ⅳ. According to the occurrence of postoperative arrhythmia, the patients were divided into a non-postoperative arrhythmia group and a postoperative arrhythmia group. The clinical data of the two groups were compared, and the influencing factors for arrhythmia after heart valve replacement were analyzed by logistic regression analysis.Results There were 96 (45%) patients with new arrhythmia after heart valve replacement surgery, and the most common type of arrhythmia was atrial fibrillation (45 patients, 18.44%). Preoperative arrhythmia rate, atrial fibrillation operation rate, postoperative minimum blood potassium value, blood magnesium value in the postoperative arrhythmia group were significantly lower than those in the non-postoperative arrhythmia group (P<0.05); hypoxemia incidence, hyperglycemia incidence, acidosis incidence, fever incidence probability were significantly higher than those in the non-postoperative arrhythmia group (P<0.05). The independent risk factors for postoperative arrhythmia were the lowest postoperative serum potassium value (OR=0.305, 95%CI 0.114-0.817), serum magnesium value (OR=0.021, 95%CI 0.002-0.218), and hypoxemia (OR=2.490, 95%CI 1.045-5.930).Conclusion Taking precautions before surgery, improving hypoxemia after surgery, maintaining electrolyte balance and acid-base balance, monitoring blood sugar, detecting arrhythmia as soon as possible and dealing with it in time can shorten the ICU stay time, reduce the occurrence of complications, and improve the prognosis of patients.

Citation： YAN Manrong, ZHONG Qianjin, GOU Yongchao, CHEN Jianming, HU Yijie, SONG Yi, YUAN Ye. Analysis of risk factors for arrhythmia in patients after heart valve replacement. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2021, 28(4): 459-466. doi: 10.7507/1007-4848.202004072 Copy

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2.	Iliescu AC, Salaru DL, Achitei I, et al. Postoperative atrial fibrillation prediction following isolated surgical aortic valve replacement. Anatol J Cardiol, 2018, 19(6): 394-400.
3.	梁克, 谢占强, 程可洛, 等. 阜外瓣膜手术风险评分及EuroSCOREⅡ对心瓣膜手术主要并发症的预测效果比较. 齐齐哈尔医学院学报, 2019, 40(5): 544-546.
4.	Todorov H, Janssen I, Honndorf S, et al. Clinical significance and risk factors for new onset and recurring atrial fibrillation following cardiac surgery-A retrospective data analysis. BMC Anesthesiol, 2017, 17(1): 163.
5.	Xu TY, Sun JP, Lee AP, et al. Left atrial function as assessed by speckle- Tracking echocardiography in hypertensio. Medicine (Baltimore), 2015, 94(6): 526.
6.	Bouchot O, Guenancia C, Kahli A, et al. Low circulating levels of growth differentiation factor-15 before coronary artery bypass surgery may predict postoperative atrial fibrillation. J Cardiothorac Vasc Anesth, 2015, 29(5): 1131-1139.
7.	刘迪, 杜鹏, 张曙光, 等. 单极与双极射频消融治疗房颤的临床效果对比. 医药论坛杂志, 2017, 38(12): 49-52.
8.	徐辉, 葛建军, 汪洋, 等. 心脏瓣膜置换同期行改良双极房颤射频消融术的安全性及有效性评价. 安徽医学, 2019, 4(40): 381-384.
9.	李苏雷, 智光, 穆洋, 等. 超声心动图评价阵发性房颤患者射频消融术后左房结构和功能改变. 中国医学影像学杂志, 2017, 25(5): 370-373.
10.	Nair SG. Atrial fibrillation after cardiac surgery. Ann Card Anaesth, 2010, 13(3): 196-205.
11.	魏培坚, 郭惠明. 心脏外科术后心房颤动与炎症反应的关系. 岭南心血管病杂志, 2019, 25(4): 484-488.
12.	O'Neal WT, Venkatesh S, Broughton ST, et al. Biomarkers and the prediction of atrial fibrillation: State of the art. Vasc Health Risk Manag, 2016, 12: 297-303.
13.	Dawood FZ, Judd S, Howard VJ, et al. High-sensitivity C-reactive protein and risk of stroke in atrial fibrillation (from the reasons for geographic and racial differences in stroke study). Am J Cardiol, 2016, 118(12): 1826-1830.
14.	An J, Shi F, Liu S, et al. Preoperative statins as modifiers of cardiac and inflammatory outcomes following coronary artery bypass graft surgery: A meta-analysis. Interact Cardiovasc Thorac Surg, 2017, 25(6): 958-965.
15.	何启燕. 继发性低钾血症致室性心律失常的心电图特点及治疗策略分析. 重庆医学, 2018, 47(20): 2742-2743, 2746.
16.	张融, 佟爽, 小刘佳, 等. 探讨心脏瓣膜术后严重并发症的护理措施. 饮食保健, 2019, 6(31): 166.
17.	陈兰, 孟庆香. 隐性低镁与心衰合并室性心律失常的相关研究. 中国地方病防治杂志, 2017, 32(9): 1010-1011.
18.	刘换岭, 白杰云, 王宽全, 等. 酸中毒后室性心律失常仿真研究. 生物化学与生物物理进展, 2016, 43(7): 716-724.
19.	黄润, 戴垚, 张婷婷. 体外循环术后患者应激性高血糖预后观察. 心脑血管病防治, 2019, 19(6): 579-581.
20.	Surer S, Seren M, Saydam O, et al. The relationship between HbA1c & atrial fibrillation after off-pump coronary artery bypass surgery in diabetic patients. Pak J Med Sci, 2016, 32(1): 59-64.
21.	欧水珍, 艾欣雨, 谢雪均. 心脏瓣膜置换术后发热原因分析及防治策略探讨. 岭南心血管病杂志, 2018, 24(2): 226-227.
22.	Chua SK, Shyu KG, Lu MJ, et al. Renal dysfunction and the risk of postoperative atrial fibrillation after cardiac surgery: Role beyond the CHA2DS2-VASc score. Europace, 2015, 17(9): 1363-1370.
23.	Cameron MJ, Tran DTT, Abboud J, et al. Prospective external validation of three preoperative risk scores for prediction of new onset atrial fibrillation after cardiac surgery. Anesth Analg, 2018, 126(1): 33-38.

1. 高润霖. 中国心瓣膜病现状. 华西医学, 2018, 33(2): 127-131.
2. Iliescu AC, Salaru DL, Achitei I, et al. Postoperative atrial fibrillation prediction following isolated surgical aortic valve replacement. Anatol J Cardiol, 2018, 19(6): 394-400.
3. 梁克, 谢占强, 程可洛, 等. 阜外瓣膜手术风险评分及EuroSCOREⅡ对心瓣膜手术主要并发症的预测效果比较. 齐齐哈尔医学院学报, 2019, 40(5): 544-546.
4. Todorov H, Janssen I, Honndorf S, et al. Clinical significance and risk factors for new onset and recurring atrial fibrillation following cardiac surgery-A retrospective data analysis. BMC Anesthesiol, 2017, 17(1): 163.
5. Xu TY, Sun JP, Lee AP, et al. Left atrial function as assessed by speckle- Tracking echocardiography in hypertensio. Medicine (Baltimore), 2015, 94(6): 526.
6. Bouchot O, Guenancia C, Kahli A, et al. Low circulating levels of growth differentiation factor-15 before coronary artery bypass surgery may predict postoperative atrial fibrillation. J Cardiothorac Vasc Anesth, 2015, 29(5): 1131-1139.
7. 刘迪, 杜鹏, 张曙光, 等. 单极与双极射频消融治疗房颤的临床效果对比. 医药论坛杂志, 2017, 38(12): 49-52.
8. 徐辉, 葛建军, 汪洋, 等. 心脏瓣膜置换同期行改良双极房颤射频消融术的安全性及有效性评价. 安徽医学, 2019, 4(40): 381-384.
9. 李苏雷, 智光, 穆洋, 等. 超声心动图评价阵发性房颤患者射频消融术后左房结构和功能改变. 中国医学影像学杂志, 2017, 25(5): 370-373.
10. Nair SG. Atrial fibrillation after cardiac surgery. Ann Card Anaesth, 2010, 13(3): 196-205.
11. 魏培坚, 郭惠明. 心脏外科术后心房颤动与炎症反应的关系. 岭南心血管病杂志, 2019, 25(4): 484-488.
12. O'Neal WT, Venkatesh S, Broughton ST, et al. Biomarkers and the prediction of atrial fibrillation: State of the art. Vasc Health Risk Manag, 2016, 12: 297-303.
13. Dawood FZ, Judd S, Howard VJ, et al. High-sensitivity C-reactive protein and risk of stroke in atrial fibrillation (from the reasons for geographic and racial differences in stroke study). Am J Cardiol, 2016, 118(12): 1826-1830.
14. An J, Shi F, Liu S, et al. Preoperative statins as modifiers of cardiac and inflammatory outcomes following coronary artery bypass graft surgery: A meta-analysis. Interact Cardiovasc Thorac Surg, 2017, 25(6): 958-965.
15. 何启燕. 继发性低钾血症致室性心律失常的心电图特点及治疗策略分析. 重庆医学, 2018, 47(20): 2742-2743, 2746.
16. 张融, 佟爽, 小刘佳, 等. 探讨心脏瓣膜术后严重并发症的护理措施. 饮食保健, 2019, 6(31): 166.
17. 陈兰, 孟庆香. 隐性低镁与心衰合并室性心律失常的相关研究. 中国地方病防治杂志, 2017, 32(9): 1010-1011.
18. 刘换岭, 白杰云, 王宽全, 等. 酸中毒后室性心律失常仿真研究. 生物化学与生物物理进展, 2016, 43(7): 716-724.
19. 黄润, 戴垚, 张婷婷. 体外循环术后患者应激性高血糖预后观察. 心脑血管病防治, 2019, 19(6): 579-581.
20. Surer S, Seren M, Saydam O, et al. The relationship between HbA1c & atrial fibrillation after off-pump coronary artery bypass surgery in diabetic patients. Pak J Med Sci, 2016, 32(1): 59-64.
21. 欧水珍, 艾欣雨, 谢雪均. 心脏瓣膜置换术后发热原因分析及防治策略探讨. 岭南心血管病杂志, 2018, 24(2): 226-227.
22. Chua SK, Shyu KG, Lu MJ, et al. Renal dysfunction and the risk of postoperative atrial fibrillation after cardiac surgery: Role beyond the CHA2DS2-VASc score. Europace, 2015, 17(9): 1363-1370.
23. Cameron MJ, Tran DTT, Abboud J, et al. Prospective external validation of three preoperative risk scores for prediction of new onset atrial fibrillation after cardiac surgery. Anesth Analg, 2018, 126(1): 33-38.

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