Abnormal heart rate variability and atrial fibrillation after aortic surgery

Revista Brasileira de Cirurgia Cardiovascular

Leonida Compostella¹  Nicola Russo¹  Augusto D’onofrio¹  Tiziana Setzu¹  Caterina Compostella¹  Tomaso Bottio¹  Gino Gerosa¹  Fabio Bellotto¹ 

关键词: Autonomic Nervous System;    Atrial Fibrillation;    Aortic Aneurysm;    Heart Rate;    Sistema Nervoso Autônomo;    Fibrilação Atrial;    Aneurisma Aórtico;    Frequência Cardíaca;   

DOI  :  10.5935/1678-9741.20140100

来源: SciELO

【 摘 要 】

Introduction: Complete denervation of transplanted heart exerts protective effect against postoperative atrial fibrillation; various degrees of autonomic denervation appear also after transection of ascending aorta during surgery for aortic aneurysm. Objective: This study aimed to evaluate if the level of cardiac denervation obtained by resection of ascending aorta could exert any effect on postoperative atrial fibrillation incidence. Methods: We retrospectively analysed the clinical records of 67 patients submitted to graft replacement of ascending aorta (group A) and 132 with aortic valve replacement (group B); all episodes of postoperative atrial fibrillation occurred during the 1-month follow-up have been reported. Heart Rate Variability parameters were obtained from a 24-h Holter recording; clinical, echocardiographic and treatment data were also evaluated. Results: Overall, 45% of patients (group A 43%, group B 46%) presented at least one episode of postoperative atrial fibrillation. Older age (but not gender, abnormal glucose tolerance, ejection fraction, left atrial diameter) was correlated with incidence of postoperative atrial fibrillation. Only among a subgroup of patients with aortic transection and signs of greater autonomic derangement (heart rate variability parameters below the median and mean heart rate over the 75th percentile), possibly indicating more profound autonomic denervation, a lower incidence of postoperative atrial fibrillation was observed (22% vs. 54%). Conclusion: Transection of ascending aorta for repair of an aortic aneurysm did not confer any significant protective effect from postoperative atrial fibrillation in comparison to patients with intact ascending aorta. It could be speculated that a limited and heterogeneous cardiac denervation was produced by the intervention, creating an eletrophysiological substrate for the high incidence of postoperative atrial fibrillation observed.

【 授权许可】

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