Left Atrial Volume Predicts the Risk of Atrial Fibrillation After Cardiac Surgery

Osranek, Martin; Fatema, Kaniz; Qaddoura, Fatema; Alsaileek, Ahmed; Barnes, Marion E.; Bailey, Kent R.; Gersh, Bernard J.; Tsang, Teresa S.M.; Zehr, Kenton J.; Seward, James B.

doi:10.1016/j.jacc.2006.03.054

Cited by 165 publications

(141 citation statements)

References 43 publications

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“…The same investigators also identified LA volume as an independent predictor of AF after cardiac surgery. 23 In addition, LA volume index is a powerful predictor of stroke in AF. 24,25 In general, LA size may be a marker of the state of vasculature as it also predicts adverse cardiovascular outcomes regardless of AF.…”

Section: La Size and Shapementioning

confidence: 99%

Atrial Fibrillation Pathophysiology and Prognosis

Siontis

Gersh

2015

Circ: Cardiovascular Imaging

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Section: La Size and Shapementioning

confidence: 99%

Atrial Fibrillation Pathophysiology and Prognosis

Siontis

Gersh

2015

Circ: Cardiovascular Imaging

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“…Osranek et al found that LAVI >32 ml/m 2 was associated with a nearly 5-fold increase in the risk of POAF in cardiac and ascending thoracic surgery. 15 Naito et al reported that LAVI ≥52 ml/m 2 was a predictor of POAF in patients with AS without coronary artery disease. 16 In that study, LAVI was larger in patients with than in those without POAF (P=0.047); however, logistic regression analysis did not show that LAVI was a significant predictor (P=0.053), which may have been related to the small sample.…”

Section: Takahashi S Et Almentioning

confidence: 99%

Preoperative Tissue Doppler Imaging-Derived Atrial Conduction Time Can Predict Postoperative Atrial Fibrillation in Patients Undergoing Aortic Valve Replacement for Aortic Valve Stenosis

Takahashi

Fujiwara

Watadani

et al. 2014

Circ J

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Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp and postoperative complications and requirements, have been evaluated as predictors of POAF; however, most of these predictors were not consistent among studies and only advanced age was a consistent predictor. 6 Recently, echocardiographic assessments have achieved much better prediction of POAF by measuring the left atrium-related values including the left atrial volume index (LAVI), LA strain and total atrial conduction time (TACT). Although there are several measurements of TACT, the time interval from the P-wave onset on the electrocardiogram (ECG) to the peak of the A' lateral wave on TDI (PA-TDI duration) provides a reliable estimation of TACT, and the PA-TDI duration has been shown to be significantly related to new-onset AF. 7,8 Our previous study revealed that the PA-TDI duration was predictive of AF in patients undergoing off-pump coronary artery bypass grafting (CABG). 9 trial fibrillation (AF) is a common complication after cardiac surgery, occurring in 10-65% of the patients. 1 Several studies have found adverse outcomes associated with postoperative AF (POAF), including increased risk of hospital stay, higher risk of stroke, permanent pacemaker implantation, and increased in-hospital and long-term mortality rates. 2 The incidence of POAF is higher with valvular surgery. 3 Obviously, in aortic valve (AV) surgery, the incidence of AF is related to these postoperative complications. 4 Moreover, Filardo et al reported that new-onset POAF was significantly associated with increased long-term risk of mortality in patients undergoing AV replacement (AVR) surgery. 5 These results indicate that POAF should be prevented and controlled postoperatively.In the past 2 decades, many clinical variables, including preoperative characteristics, comorbidities, intraoperative findings A

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“…16 Left atrial volume is a strong and independent predictor of postoperative AF after cardiac surgery. 17 In 254 elderly persons with AF compared to 1,445 elderly persons with sinus rhythm, mean age 81 years, 2-dimensional and Doppler echocardiography demonstrated that the prevalence of AF was increased 17.1 times by rheumatic mitral stenosis, 2.9 times by left atrial enlargement, 2.5 times by abnormal LV ejection fraction, 2.3 times by aortic stenosis, 2.2 times by MAC and by ≥1+ mitral regurgitation, 2.1 times by ≥ 1+ aortic regurgitation, and 2.0 times by LV hypertrophy. 18 The Framingham Study showed that low serum thyrotropin levels were independently associated with a 3.1 times increase in the development of new AF in older patients.…”

Section: Predisposing Factorsmentioning

confidence: 99%

Atrial Fibrillation: The New Epidemic of the Ageing World

Aronow¹,

Banach²

2009

J.A.F.I.B

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The prevalence of atrial fibrillation (AF) increases with age. As the population ages, the burden of AF increases.AF is associated with an increased incidence of mortality, stroke, and coronary events compared to sinus rhythm. AF with a rapid ventricular rate may cause a tachycardia-related cardiomyopathy. Immediate direct-current (DC) cardioversion should be performed in patients with AF and acute myocardial infarction, chest pain due to myocardial ischemia, hypotension, severe heart failure, or syncope. Intravenous beta blockers, diltiazem, or verapamil may be administered to reduce immediately a very rapid ventricular rate in AF. An oral beta blocker, verapamil, or diltiazem should be used in persons with AF if a fast ventricular rate occurs at rest or during exercise despite digoxin. Amiodarone may be used in selected patients with symptomatic life-threatening AF refractory to other drugs. Digoxin should not be used to treat patients with paroxysmal AF. Nondrug therapies should be performed in patients with symptomatic AF in whom a rapid ventricular rate cannot be slowed by drugs. Paroxysmal AF associated with the tachycardia-bradycardia syndrome should be treated with a permanent pacemaker in combination with drugs. A permanent pacemaker should be implanted in patients with AF and symptoms such as dizziness or syncope associated with ventricular pauses greater than 3 seconds which are not drug-induced. Elective DC cardioversion has a higher success rate and a lower incidence of cardiac adverse effects than does medical cardioversion in converting AF to sinus rhythm. Unless transesophageal echocardiography has shown no thrombus in the left atrial appendage before cardioversion, oral warfarin should be given for 3 weeks before elective DC or drug cardioversion of AF and continued for at least 4 weeks after maintenance of sinus rhythm. Many cardiologists prefer, especially in elderly patients , ventricular rate control plus warfarin rather than maintaining sinus rhythm with antiarrhythmic drugs. Patients with chronic or paroxysmal AF at high risk for stroke should be treated with long-term warfarin to achieve an International Normalized Ratio of 2.0 to 3.0. Patients with AF at low risk for stroke or with contraindications to warfarin should be treated with aspirin 325 mg daily

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Left Atrial Volume Predicts the Risk of Atrial Fibrillation After Cardiac Surgery

Abstract: The LAV is a strong and independent predictor of POAF. Risk stratification using LAV and age enables clinicians to identify high-risk patients before cardiac surgery.

Cited by 165 publications

References 43 publications

Atrial Fibrillation Pathophysiology and Prognosis

Atrial Fibrillation Pathophysiology and Prognosis

Preoperative Tissue Doppler Imaging-Derived Atrial Conduction Time Can Predict Postoperative Atrial Fibrillation in Patients Undergoing Aortic Valve Replacement for Aortic Valve Stenosis

Atrial Fibrillation: The New Epidemic of the Ageing World

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