Hemodynamic parameters predict the risk of atrial fibrillation after cardiac surgery in adults

Abstract

Background Postoperative atrial fibrillation (POAF) is a common complication following cardiac surgery and is associated with poorer prognosis. This study attempted to evaluate whether hemodynamic parameters determined by a right heart catheter predict the occurrence of POAF. Hypothesis We hypothesized that atrial fibrillation after cardiac surgery can be predicted by hemodynamic parameters determined by a right heart catheter. Methods Between October 2015 and January 2017, 126 patients with preoperative sinus rhythm undergoing coronary artery bypass grafting and/or aortic valve replacement were enrolled in this study. Complete echocardiographic examination was performed preoperatively, and hemodynamic parameters were recorded via a right heart catheter before anesthesia induction. Postoperative telemetry strips and electrocardiogram were used to detect atrial fibrillation until discharge. Multivariate logistic regression was used to identify risk factors of POAF. Results The overall incidence of POAF was 40/126 (31.7%). Multivariate logistic regression analysis determined that left atrial dimension (LAD) (adjusted odds ratio [OR]: 1.118, 95% confidence interval [CI]: 1.020‐1.227, P = 0.018), pulmonary capillary wedge pressure (PCWP) (adjusted OR: 1.225, 95% CI: 1.082‐1.387, P = 0.001), and pulmonary artery systolic pressure (PASP) (adjusted OR: 1.076, 95% CI: 1.019‐1.137, P = 0.008) were significant predictors of POAF. Conclusions The present study suggested that LAD, PCWP, and PASP were robust predictors of POAF. These parameters may indicate a patient's susceptibility toward developing POAF and help to identify patients who need preventive treatment.

Optimising risk factors for atrial fibrillation post-cardiac surgery

“…48,56,61 Preoperative echocardiogram changes in left atrial anatomy secondary to diastolic dysfunction also show a strong link with POAF; these include atrial dilatation, hypertrophy, increased volume and increasing left atrial volume indexed to body area (LAV i ) (Table 1), which is thought to be the greatest predictive factor of these. 48,49,[59][60][61][62][63][64][65] Novel two-dimensional speckle-tracking echocardiography (2D-STE) has shown that longitudinal strain and augmented left ventricular twist and untwisting velocity identified prior to cardiac surgery correlates with POAF incidence. 49,64,65 Medications A wealth of literature supports the prophylactic use of preoperative beta-blockers against POAF (OR: 0.33; 95% CI).…”

“…1,7,26,40,45 Prior to surgery, all patients should have an ECG and echocardiogram performed to inform risk stratification. 40,44,[53][54][55][56][57][58][59][60][61][62][63][64][65] The use of universal preoperative betablockers has a strong evidence base, with amiodarone and sotalol proving effective. 23,24,26,27,29,30,51,66 More data is required to determine the timing of administration to provide optimal prophylaxis.…”

Role of pre-operative transthoracic echocardiography in predicting post-operative atrial fibrillation after cardiac surgery: a systematic review of the literature and meta-analysis

“…[6][7][8][9][10][11] Several studies identified parameters representing left atrial (LA) structural remodelling, such as LA volume (LAV), LA diameter (LAD), LA area, and LA size, to be associated with POAF. 26,[28][29][30][31][34][35][36]50 , Also, diastolic dysfunction, reduced LA ejection fraction (LAEF), and reduced left ventricular ejection fraction (LVEF) were independent predictors of POAF. 7,24,27,[31][32][33]37,42,50 These variables were not assessed in a meta-analysis, since there were no more than five publications reporting them as independent predictors of POAF in multivariable analysis.…”

Hemodynamic indicators informativity in ischemic heart disease patients for forecasting results of coronary artery bypass grafting

“…ст. риск послеоперационной фибрилляции предсердий возрастает на 14,3 % [31]. Увеличение длительности Р-волны более 150 мс на электрокардиограмме ассоциируется почти с пятикратным увеличением риска фибрилляции предсердий в первые сутки после АКШ, что обусловлено замедлением электрической активации за счет объемной перегрузки левого предсердия.…”

“…ст. (отношение шансов -5), кардиомегалия с конечным диастолическим объемом левого желудочка более 200 мл (отношение шансов -2,3) [31]. К предикторам ранних неврологических осложнений помимо послеоперационной фибрилляции предсердий относят выявляемые при чреспищеводной ЭхоКГ мягкие, подвижные и выступающие в просвет дуги аорты атеросклеротические бляшки.…”