PREOPERATIVE PREDICTORS OF RECURRENT ATRIAL-FIBRILLATION LATE AFTER SUCCESSFUL MITRAL-VALVE RECONSTRUCTION

Objective: Late outcome after mitral valve repair was examined to defi ne preoperative predictors of recurrent atrial fibrillation late after successful mitral valve reconstruction. Methods: One hundred and eigh ty-nine patients, 112 with preoperative sinus rhythm and 72 with preop erative chronic or intermittent atrial fibrillation, were followed for 12.2+/-10 years after valve repair. Clinic, hemodynamic end echocardi ographic data were entered into Cox-regression and Kaplan-Meyer analys is to assess predictors for recurrent atrial fibrillation late after s uccessful mitral valve repair. Results: Univariate and multivariate pr edictors for recurrent atrial fibrillation late after successful mitra l valve reconstruction were preoperative atrial fibrillation (P = 0.00 01), preoperative antiarrhythmic drug treatment (P = 0.005), heart rat e (P = 0.01), left ventricular ejection fraction (P = 0.01) and increa sed left ventricular posterior wall thickness (P = 0.05). Patients > 5 7.5 years with a mean pulmonary artery pressure greater than or equal to 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 at rial fibrillation late after successful mitral valve repair. Conclusio n: Older patients with a history of atrial fibrillation, antiarrhythmi c treatment or an elevated pulmonary artery pressure may present atria l fibrillation late after successful mitral valve repair. They could b e considered for combined mitral valve reconstruction and surgery for atrial fibrillation even though sinus rhythm is present preoperatively . (C) 1998 Elsevier Science B.V. All rights reserved.