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, 謝占強, 程可洛, 等. 阜外瓣膜手術風險評分及EuroSCOREⅡ對心瓣膜手術主要并發癥的預測效果比較. 齊齊哈爾醫學院學報, 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.	劉迪, 杜鵬, 張曙光, 等. 單極與雙極射頻消融治療房顫的臨床效果對比. 醫藥論壇雜志, 2017, 38(12): 49-52.
8.	徐輝, 葛建軍, 汪洋, 等. 心臟瓣膜置換同期行改良雙極房顫射頻消融術的安全性及有效性評價. 安徽醫學, 2019, 4(40): 381-384.
9.	李蘇雷, 智光, 穆洋, 等. 超聲心動圖評價陣發性房顫患者射頻消融術后左房結構和功能改變. 中國醫學影像學雜志, 2017, 25(5): 370-373.
10.	Nair SG. Atrial fibrillation after cardiac surgery. Ann Card Anaesth, 2010, 13(3): 196-205.
11.	魏培堅, 郭惠明. 心臟外科術后心房顫動與炎癥反應的關系. 嶺南心血管病雜志, 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.	何啟燕. 繼發性低鉀血癥致室性心律失常的心電圖特點及治療策略分析. 重慶醫學, 2018, 47(20): 2742-2743, 2746.
16.	張融, 佟爽, 小劉佳, 等. 探討心臟瓣膜術后嚴重并發癥的護理措施. 飲食保健, 2019, 6(31): 166.
17.	陳蘭, 孟慶香. 隱性低鎂與心衰合并室性心律失常的相關研究. 中國地方病防治雜志, 2017, 32(9): 1010-1011.
18.	劉換嶺, 白杰云, 王寬全, 等. 酸中毒后室性心律失常仿真研究. 生物化學與生物物理進展, 2016, 43(7): 716-724.
19.	黃潤, 戴垚, 張婷婷. 體外循環術后患者應激性高血糖預后觀察. 心腦血管病防治, 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.	歐水珍, 艾欣雨, 謝雪均. 心臟瓣膜置換術后發熱原因分析及防治策略探討. 嶺南心血管病雜志, 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. 高潤霖. 中國心瓣膜病現狀. 華西醫學, 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, 謝占強, 程可洛, 等. 阜外瓣膜手術風險評分及EuroSCOREⅡ對心瓣膜手術主要并發癥的預測效果比較. 齊齊哈爾醫學院學報, 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. 劉迪, 杜鵬, 張曙光, 等. 單極與雙極射頻消融治療房顫的臨床效果對比. 醫藥論壇雜志, 2017, 38(12): 49-52.
8. 徐輝, 葛建軍, 汪洋, 等. 心臟瓣膜置換同期行改良雙極房顫射頻消融術的安全性及有效性評價. 安徽醫學, 2019, 4(40): 381-384.
9. 李蘇雷, 智光, 穆洋, 等. 超聲心動圖評價陣發性房顫患者射頻消融術后左房結構和功能改變. 中國醫學影像學雜志, 2017, 25(5): 370-373.
10. Nair SG. Atrial fibrillation after cardiac surgery. Ann Card Anaesth, 2010, 13(3): 196-205.
11. 魏培堅, 郭惠明. 心臟外科術后心房顫動與炎癥反應的關系. 嶺南心血管病雜志, 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. 何啟燕. 繼發性低鉀血癥致室性心律失常的心電圖特點及治療策略分析. 重慶醫學, 2018, 47(20): 2742-2743, 2746.
16. 張融, 佟爽, 小劉佳, 等. 探討心臟瓣膜術后嚴重并發癥的護理措施. 飲食保健, 2019, 6(31): 166.
17. 陳蘭, 孟慶香. 隱性低鎂與心衰合并室性心律失常的相關研究. 中國地方病防治雜志, 2017, 32(9): 1010-1011.
18. 劉換嶺, 白杰云, 王寬全, 等. 酸中毒后室性心律失常仿真研究. 生物化學與生物物理進展, 2016, 43(7): 716-724.
19. 黃潤, 戴垚, 張婷婷. 體外循環術后患者應激性高血糖預后觀察. 心腦血管病防治, 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. 歐水珍, 艾欣雨, 謝雪均. 心臟瓣膜置換術后發熱原因分析及防治策略探討. 嶺南心血管病雜志, 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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