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Eur J Cardiothorac Surg 1998;13:619-624
© 1998 Elsevier Science NL

Preoperative predictors of recurrent atrial fibrillation late after successful mitral valve reconstruction¹

^a Clinic for Cardiovascular Surgery, University Hospital, Ramistrasse 100, 8091 Zurich, Switzerland
^b Clinic for Cardiovascular Cardiology, University Hospital, Ramistrasse 100, 8091 Zurich, Switzerland

Received 19 November 1997; received in revised form 4 March 1998; accepted 10 March 1998.

Corresponding author. Tel.: +41 1 2551111; fax: +41 1 2554446; e-mail: paul.vogt@chi.usz.ch

Objective: Late outcome after mitral valve repair was examined to define preoperative predictors of recurrent atrial fibrillation late after successful mitral valve reconstruction. Methods: One hundred and eighty-nine patients, 112 with preoperative sinus rhythm and 72 with preoperative chronic or intermittent atrial fibrillation, were followed for 12.2±10 years after valve repair. Clinic, hemodynamic end echocardiographic data were entered into Cox-regression and Kaplan–Meyer analysis to assess predictors for recurrent atrial fibrillation late after successful mitral valve repair. Results: Univariate and multivariate predictors for recurrent atrial fibrillation late after successful mitral valve reconstruction were preoperative atrial fibrillation (P=0.0001), preoperative antiarrhythmic drug treatment (P=0.005), heart rate (P=0.01), left ventricular ejection fraction (P=0.01) and increased left ventricular posterior wall thickness (P=0.05). Patients>57.5 years with a mean pulmonary artery pressure 23mm Hg and a history of preoperative antiarrhythmic drug treatment had an odds ratio of 53.33 (95% confidence limits 6.12–464.54) for atrial fibrillation late after successful mitral valve repair. Conclusion: Older patients with a history of atrial fibrillation, antiarrhythmic treatment or an elevated pulmonary artery pressure may present atrial fibrillation late after successful mitral valve repair. They could be considered for combined mitral valve reconstruction and surgery for atrial fibrillation even though sinus rhythm is present preoperatively.

Key Words: Atrial fibrillation • Mitral valve • Late results