Cor Vasa 2010, 52(4):234-237 | DOI: 10.33678/cor.2010.058

Atrial fibrillation in patients with significant aortic stenosis

Roman Surovčík^1,*, Pavel Jebavý¹, Karel Hlaváček¹, Rudolf Feuereisl¹, Petr Frídl¹, Ján Lietava²

¹ Kardiologie Na Bulovce, s. r. o., Praha, Česká republika

² II. interná klinika, Fakultná nemocnica s poliklinikou Bratislava a Lekárska fakulta Univerzity Komenského, Bratislava, Slovenská republika

Atrial fibrillation occurs in approximately 5% of patients with severe aortic stenosis. Its incidence and prevalence do not increase until the magnitude of aortic stenosis reaches a higher degree as opposed to mitral valve disease.
Aim of study: To determine the prevalence of recurrent and permanent atrial fibrillation and to assess gender differences in the prevalence in patients with severe aortic stenosis. Another primary aim was to find clinical, echocardiographic, and hemodynamic predictors of atrial fibrillation before surgical treatment.
Secondary aim: To analyze the effect of arterial hypertension, antihypertensive medication, and invasively measured blood pressure on the occurrence of atrial fibrillation.
Tertiary aim: To estimate the significance of atrial fibrillation as a predictor of 48-month mortality.

Methods: Patients assigned to our study were referred to the department of cardiology in the Na Bulovce Teaching Hospital in Prague from January 2004 to February 2008. Significance of aortic stenosis was confirmed by heart catheterization. Patients included in the database had an indexed aortic valve area ≤ 0.5 cm2/m2. The exclusion criteria were mitral valve disease of the second or higher degree and aortic regurgitation of the second or higher degree as assessed by echocardiography.

Results: Our group of patients consisted of 204 persons with severe aortic stenosis (118 men and 86 women) with an aortic valve area < 0.5 cm2/m2. Their mean age was 72.2 years (women 74.6; men 70.4 years). Atrial fibrillation was present in 13.7% of patients with severe aortic stenosis. It was non-significantly more common in women than in men (17% vs. 11.2%; p = 0.23). The only independent predictor of atrial fibrillation was left atrial dilatation (p = 0.001). The indexed left ventricular mass turned out to be of borderline significance (p = 0.06) as was left ventricular ejection fraction (p = 0.07). Atrial fibrillation was significantly more commonly associated with diuretic use (OR 3.9, p = 0.02, CI 1.13-13.4). Presence of atrial fibrillation non-significantly increased 2-year mortality (OR 1.62, p = 0,3, CI 0.623-4.215).

Conclusion: Atrial fibrillation belongs to the most common arrhythmias in patients with severe aortic stenosis. In our group of patients, atrial fibrillation was present in 13.7% of patients. The only independent predictor of atrial fibrillation was left atrial dilatation. Arterial hypertension and its therapy did not have a significant effect on the occurrence of atrial fibrillation with the exception of diuretic use.

Keywords: Atrial fibrillation; Aortic stenosis; Predictors; Arterial hypertension

Published: April 1, 2010  Show citation