Objectives .– In a series of patients with severe symptomatic aortic stenosis (AS), we sought to assess the value of left ventricular global longitudinal strain (GLS) using 2D speckle tracking to predict the occurrence of atrial fibrillation (AF) after aortic valve replacement (AVR).

Background .– AF following cardiac surgery is a common complication increasing risks of embolic events, hemodynamic instability, postoperative heart failure, hemorrhagic complications and increasing in-hospital length of stay.

Methods .– Thirty-one consecutive patients (17 males, 55%), aged (72 ± 9) with severe symptomatic AS (area < 1 cm ² ), who underwent aortic valve replacement (AVR) were prospectively included in two centers between 2009 and 2010. A complete preoperative echocardiography was performed in all patients, including global and segmental longitudinal strain using 2D speckle tracking. AF was divided into paroxysmal AF when AF lasted less than 48 h and persistent when AF remained at discharge.

Results .– The incidence of postoperative AF was (19/31, 61%). Nine patients had paroxysmal AF and 10 had persistent AF. On univariate analysis, heavy weight ( P = 0.038) and GLS ( P = 0.01) were the only predictors of paroxysmal postoperative AF. Using ROC curves, a cut-off value of −15% for GLS could predict paroxysmal AF with a sensitivity of 74% and a specificity of 67%; area under curve (AUC) 0.75.

On univariate analysis, increased LV end systolic diameter ( P = 0.006), E/E’ ratio ( P = 0.003), systolic pulmonary artery pressure ( P = 0.03), LV ejection fraction ( P = 0.006) and GLS ( P = 0.01) were the only predictors of persistent AF. Using ROC curves, a cut-off value of −15% for GLS could predict persistent AF with a sensitivity of 90% and a specificity of 67%; AUC 0.87.

Conclusions .– Decreased preoperative GLS could predict postoperative paroxysmal and persistent AF. The best sensitivity and specificity were obtained with a cut-off value for GLS of −15%. Indeed, prophylactic antiarrythmic therapy should be particularly proposed in patients with impaired longitudinal systolic function before AVR.