Early and late post-operative arrhythmias after surgical myectomy: 45 years of follow-up

Abstract

Aims: The aims of this study are to investigate the incidence and determinants of post-operative atrial arrhythmias, conduction disorders and mortality in hypertrophic obstructive cardiomyopathy (HOCM) patients undergoing transaortic myectomy. Methods and results: This retrospective single-center study was conducted in 249 patients (median age 54 years , 42% female) undergoing transaortic myectomy. Post-operative atrial fibrillation (AF) was reported in 84 patients (33.7%), including 56 patients (22.5%) with de novo AF. Older age (HR = 1.027 (1.003-1.052), p = 0.029) and hypercholesterolemia (HR = 2.296 (1.091-4.832) p = 0.029) were independent predictors for de novo post-operative AF. Late post-operative AF and atrial flutter (AFL) occurred in 18.9% and 6.8% of the patients, respectively. De novo early post-operative AF increased the risk of late post-operative AF (HR = 3.138 (1.450-6.789), p = 0.004). Patients with a right bundle branch block had a higher risk of early-postoperative pacemaker implantation (p = 0.003, HR = 9.771 (2.195-43.505)). Higher age at time of surgery (HR = 1.053 (1.026-1.081), p < 0.001) was a predictor for late mortality (n = 47, 18.9%). Conclusion:Early and late post-operative AF, AFL and other SVTs are common sequelae after myectomy and are associated with older age at surgery, history of AF and early post-operative AF. Early post-operative arrhythmias are not transient and periodic rhythm monitoring is therefore essential to initiate therapy as soon as possible.

Transaortic Shallow Septal Myectomy and Cutting of Secondary Fibrotic Mitral Valve Chordae—A 5-Year Single-Center Experience in the Treatment of Hypertrophic Obstructive Cardiomyopathy

“…Patients’ demographic data were comparable with statistics reported by Romanian Registry of Hypertrophic Cardiomyopathy [ 9 ] or other cohorts of Romanian patients with HCM [ 10 ], with a mean age falling in the sixth decade of life, and with male predominance. Baseline clinical characteristics and echocardiography findings were similar with those from other European centres [ 11 , 12 ]. Preoperatively, the majority of our subjects (59%) were either in NYHA class III or IV, with a mean IVS thickness of 24 ± 6 mm and a mean LVOT gradient of 93 ± 33 mmHg.…”

Determinants of atrial fibrillation after cardiac surgery

“…Advancing age is the most widely proven major predictor in the occurrence of POAF [27][28][29][30][31]. In patients aged 72 years or older, the risk of POAF is approximately five times greater than in patients who are aged 55 or younger [2].…”

Impact of Body Mass Index on Postoperative Atrial Fibrillation in Patients With Hypertrophic Cardiomyopathy Undergoing Septal Myectomy

“…To date, the only studies have drawn inconsistent conclusions. 11 , 12 , 13 Although further studies are needed on the impact of POAF on long‐term clinical course in OHCM, we speculate that the impact of POAF on the prognosis of patients with OHCM is less severe than that of patients with other cardiovascular conditions.…”

“…The few previous studies have determined that the impact of POAF on the prognosis of the disease is different between patients with OHCM and other cardiac surgical populations, which suggests that POAF in OHCM is unique. 11 , 12 , 13 As a common complication after cardiac surgery, previous studies have shown that the occurrence of POAF in Chinese population is significantly lower than that in other ethnic groups. 14 , 15 This suggests that the clinical phenotype of cardiovascular disease in Chinese population may be different from that in other populations.…”