Preoperative risk factors for atrial fibrillation and assessment of the likelihood of its occurrence in the early postoperative period after correction of severe aortic stenosis based on ultrasound examination

The aim of the study: To determine the risk factors and likelihood of developing postoperative atrial fibrillation (POAF) after aortic valve replacement (AVR) for severe aortic stenosis (AS).

Materials and methods. A multicenter retrospective-prospective study was conducted among 181 patients with severe AS who underwent isolated valve replacement using biological prostheses in 2019–2025. The subjects were divided into two groups: with postoperative AF (POAF) (n = 75) and a group without POAF (n = 106). The median age was 72 [67, 75] and 70 [67, 73] years (p = 0.206), respectively. Female gender was 49 (65.3%), 62 (58.5%) (p = 0.438).

Results. Risk factors for AF development in the early postoperative period were assessed using multivariate analysis. Statistically significant factors included: left ventricular diastolic dysfunction (LVDD) grade 2 (β = 0.90, p = 0.020, OR 2.5 (1.2–5.4)) and grade 3 (β = 1.4, p = 0.006, OR 4.0 (1.5–11.0)), presence of rhythm disturbances in the anamnesis before surgery (β = 4.04, p < 0.001, OR 57 (7–67)), and replacement of the aortic valve using implanted bioprostheses (β = 0.90, p = 0.028, 2.5 (1.1–5.6)). For further analysis of risk factors and calculation of the probability of occurrence of postoperative AF, the group including patients with POAF was divided into two subgroups: individuals with the presence of cardiac arrhythmia in the anamnesis before surgery (n = 32), and without arrhythmia in the anamnesis in the preoperative period (n = 43). In the group of patients with no preoperative cardiac arrhythmia, the presence of grade 2 LVDD, grade 3 LVDD before surgery, a biological suture prosthesis, and female gender were statistically significant risk factors for developing POAF. In the group with in the anamnesis preoperative cardiac arrhythmia, there were no other statistically significant risk factors for developing POAF, and the odds of developing POAF increased 57-fold at baseline. If a patient had grade 3 LVDD at baseline and a biological suture prosthesis was used, the risk of developing POAF increased regardless of gender.

Conclusion. Preoperative risk factors for the development of AF in the early postoperative period in individuals who underwent surgical correction of severe AS and did not have cardiac arrhythmia preoperatively were: LVDD grades 2 and 3, female gender, and bioprosthetics using implanted prostheses. The presence of paroxysmal AF or frequent atrial extrasystoles before surgery is the main risk factor for the development of POAF. The likelihood of developing AF in the early postoperative period after coronary artery bypass graft replacement for severe AS significantly increases in the presence of the above-mentioned risk factors.

1. Golitsyn S.P., Panchenko E.P., Mironov N.Yu., et al. Eurasian clinical guidelines for the diagnosis and treatment of atrial fibrillation in adult patients (2025). Eurasian Heart Journal. 2025; 3: 6–77. https://doi.org/10.38109/2225-1685-2025-3-6-77 (In Russian)

2. Joglar J.A., Chung M.K., Armbruster A.L. et al.; Peer Review Committee Members. 2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2024; 149 (1): e1–e156. https://doi.org/10.1161/CIR.0000000000001193

3. Van Gelder I.C., Rienstra M., Bunting K.V. et al.; ESC Scientific Document Group. 2024 ESC Guidelines for the management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). Eur. Heart J. 2024; 45 (36): 3314–3414. https://doi.org/10.1161/10.1093/eurheartj/ehae176

4. Kiser A.C. 2024 Literature Review of Postoperative Atrial Fibrillation: A Surgeon's Perspective. J. Innov. Card. Rhythm. Manag. 2025; 16 (1): 6154–6157. https://doi.org/10.19102/icrm.2025.16017

5. Nagueh S.F., Sanborn D.Y., Oh J.K. et al. Recommendations for the Evaluation of Left Ventricular Diastolic Function by Echocardiography and for Heart Failure With Preserved Ejection Fraction Diagnosis: An Update From the American Society of Echocardiography. J. Am. Soc. Echocardiogr. 2025; 38 (7): 537–569. https://doi.org/10.1016/j.echo.2025.03.011

6. Zherko O.M., Mikhailov A.N., Shkrebneva E.I., Oliferko N.P. Diagnostic efficiency of a new method for determining the left ventricular diastolic dysfunction in heart failure. Proceedings of the National Academy of Sciences of Belarus, Medical series. 2021; 18 (3): 292–303. https://doi.org/10.29235/1814-6023-2021-18-3-292-303 (In Russian)

7. McDonagh T.A., Metra M., Adamo M. et al.; ESC Scientific Document Group. 2023 Focused Update of the 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur. Heart J. 2023; 44 (37): 3627–3639. https://doi.org/10.1093/eurheartj/ehad195

8. Gaudino M., Di Franco A., Rong L.Q. et al. Postoperative atrial fibrillation: from mechanisms to treatment. Eur. Heart J. 2023; 44 (12): 1020–1039. https://doi.org/10.1093/eurheartj/ehad019

9. Chatterjee S., Grant M.C., Hui D.S. et al. The Society of Thoracic Surgeons 2026 Clinical Practice Guidelines for the Prevention and Treatment of New-Onset Postoperative Atrial Fibrillation After Cardiac Surgery. Ann. Thorac. Surg. 2026; 122 (2): 255–277. https://doi.org/10.1016/j.athoracsur.2026.04.002

10. Tarasevich S.V., Zherko O.M., Krachak D.I., Galitskaya S.S. Long-term results of correction of severe aortic stenosis using cardiac surgical and endovascular methods, as from radiologic control data. Medical Visualization. 2025; 29 (4): 58–72. https://doi.org/10.24835/1607-0763-1556 (In Russian)

11. Bonanni F., Caciolli S., Berteotti M. et al. Left Ventricular Diastolic Dysfunction Predicts Global Longitudinal Strain Recovery after Surgical Aortic Valve Replacement. Diagnostics (Basel). 2024; 14 (19): 2176. https://doi.org/10.3390/diagnostics14192176

12. Suero O.R., Ali A.K., Barron L.R. et al. Postoperative atrial fibrillation (POAF) after cardiac surgery: clinical practice review. J. Thorac. Dis. 2024; 16 (2): 1503–1520. https://doi.org/10.21037/jtd-23-1626

13. Knez N., Kopjar T., Tokic T., Gasparovic H. Atrial Fibrillation Prediction Model Following Aortic Valve Replacement Surgery. J. Cardiovasc. Dev. Dis. 2025; 12 (2): 52. https://doi.org/10.3390/jcdd12020052

14. Fragão-Marques M., Mancio J., Oliveira J. et al. Gender Differences in Predictors and Long-Term Mortality of New-Onset Postoperative Atrial Fibrillation Following Isolated Aortic Valve Replacement Surgery. Ann. Thorac. Cardiovasc. Surg. 2020; 26 (6): 342–351. https://doi.org/10.5761/atcs.oa.19-00314

15. Shin J., Andrews M., DeJean L. et al. Risk Factors Associated With Atrial Fibrillation in Elderly Patients. J. Clin. Med. Res. 2023; 15 (3): 148–160. https://doi.org/10.14740/jocmr4884

16. Faith M., Travis Q., Betteridge-LeBlanc S. Post-cardiac surgery atrial fibrillation and sex differences in clinical outcomes: a systematic review and meta-analysis. Eur. Heart J. Open. 2025; 5 (2): Art. oeaf033. https://doi.org/10.1093/ehjopen/oeaf033

17. Sohn S.H., Kim K.H., Kang Y. et al. Rapid deployment versus its conventional counterpart in aortic valve replacement: comparison of early hemodynamic outcomes. J. Thorac. Dis. 2023; 15 (7): 3673–3684. https://doi.org/10.21037/jtd-23-318

18. Aljalloud A., Moza A., Arias J.P. et al. Conventional vs. Sutureless Aortic Valve Bioprosthesis: Is Faster Better? J. Cardiovasc. Dev. Dis. 2023; 10 (7): 311. https://doi.org/10.3390/jcdd10070311

19. Praz F., Borger M.A., Lanz J. et al.; ESC/EACTS Scientific Document Group. 2025 ESC/EACTS Guidelines for the management of valvular heart disease. Eur. Heart. J. 2025; 46 (44): 4635–4736. https://doi.org/10.1093/eurheartj/ehaf194

20. Kassem J., Ghazal R., Fakhreddin O. et al. Assessment of Left Ventricular Global Longitudinal Strain Improvement Following Transcatheter Aortic Valve Replacement. J. Cardiovasc. Echogr. 2025; 35 (2): 129–135. https://doi.org/10.4103/jcecho.jcecho_99_24

21. Lima M.R., Abecasis J., Santos R.R. et al. Prognostic impact of left ventricular reverse remodeling after surgical aortic valve replacement in severe aortic stenosis. Sci. Rep. 2025; 15 (1): Art. 26581. https://doi.org/10.1038/s41598-025-12483-9

22. Tarasevich S.V., Zherko O.M., Galitskaya S.S. et al. Structural and functional remodeling of the left and right ventricles after bioprosthetic replacement of the aortic valve for aortic stenosis. Medical News. 2024; 9: 44–48. (In Russian)

23. Awad A.K., Elbahloul M.A., Al-Omoush O. et al. Impact of postoperative atrial fibrillation (POAF) on outcomes after coronary artery bypass grafting: A meta-analysis of unique 247,270 patients from 50 studies. Am. Heart J. Plus. 2025; 59: 100621. https://doi.org/10.1016/j.ahjo.2025.100621

24. Woldendorp K., Farag J., Khadra S. et al. Postoperative Atrial Fibrillation After Cardiac Surgery: A Meta-Analysis. Ann. Thorac. Surg. 2021; 112 (6): 2084–2093. https://doi.org/10.1016/j.athoracsur.2020.10.055