Prediction of Atrial Fibrillation After Off-Pump Coronary Artery Bypass Grafting Using Preoperative Total Atrial Conduction Time Determined on Tissue Doppler Imaging

Fujiwara, Mai; Nakano, Yukiko; Hidaka, Takayuki; Oda, Noboru; Uchimura, Yuko; Sairaku, Akinori; Kajihara, Kenta; Tokuyama, Takehito; Motoda, Chikaaki; Watanabe, Yoshikazu; Ikenaga, Hiroki; Imai, Kyoichi; Sueda, Takuya; Kihara, Yasuki

doi:10.1253/circj.cj-13-0900

Cited by 22 publications

(37 citation statements)

References 30 publications

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“…8 In our previous study in patients undergoing off-pump CABG, a PA-TDI duration >141 ms was found to be a predictor of POAF. 9 In the present study, we found that the occurrence of POAF in patients with a PA-TDI duration <130 ms (6/22 cases (27%)) and the optimal cutoff value of the PA-TDI duration was >147 ms. The difference in the optimal PA-TDI cutoff values in our 2 studies may have be related to the extent of invasive surgical manipulation and the underlying disease (coronary artery disease or AS).…”

Section: Discussionsupporting

confidence: 47%

“…27 The new information from our previous study was that the PA-TDI duration was also an independent predictor of POAF in patients undergoing offpump CABG. 9 The aim of the present study was to determine the optimal cutoff value of PA-DTI duration to predict POAF. de Vos et al showed that in 249 patients with cardiac disease, the PA-TDI study included patients who underwent isolated AVR; however, some patients had mitral valvular disease as well, which may have increased the risk of POAF.…”

Section: Study Limitationsmentioning

confidence: 98%

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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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Section: Discussionsupporting

confidence: 47%

Section: Study Limitationsmentioning

confidence: 98%

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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“…22 It is well known that POAF is influenced by multiple risk factors. 23, 24 The preoperative factors include age, hypertension and diabetes mellitus; the intraoperative factors include operative stress and atrial ischemia; and the postoperative factors include volume overload, increased cardiac afterload, and inflammation. These changes may affect the atrial structural substrate for POAF, and cause atrial extrasystoles and/or autonomic nerve imbalance, triggering electrophysiological disorders including atrial flutter and fibrillation.…”

Section: Tashiro N Et Almentioning

confidence: 99%

Efficacy of Cardiopulmonary Rehabilitation With Adaptive Servo-Ventilation in Patients Undergoing Off-Pump Coronary Artery Bypass Grafting

Tashiro

Takahashi

Takasaki

et al. 2015

Circ J

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“…Three recent echocardiographic studies assessed the predictive value of pulsed-wave (PW)- DMI in patients prior to cardiac surgery [23-25]. Here, the time interval between onset of P-wave and peak of A’-wave derived from PW-DMI of the left lateral atrial wall was measured.…”

Section: Discussionmentioning

confidence: 99%

Interatrial conduction disturbance in postoperative atrial fibrillation: a comparative study of P-wave dispersion and Doppler myocardial imaging in cardiac surgery

Hatam

Aljalloud

Mischke

et al. 2014

J Cardiothorac Surg

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ObjectiveDisturbances of interatrial conduction have been proposed as one of the contributing mechanisms of postoperative atrial fibrillation (AF). P-wave dispersion has been recognized as a sensitive tool for detecting interatrial conduction disturbances. Doppler myocardial imaging (DMI) has been validated as a non-invasive tool to indirectly reflect electrical atrial activation and therefore is used in this study to detect possible interatrial electromechanical disturbances after cardiac surgery.Methods30 patients (23 men, age 62 ± 1 years) admitted for coronary bypass surgery with no prior history of AF were included in this investigation. Echocardiography and electrocardiograms (ECG) were obtained on the day before and after surgery. In addition to standard echocardiography, DMI-loops were acquired from the apical window. The following time intervals were derived off-line from the free right atrial (RA), left atrial (LA) lateral and LA posterior wall: onset P-wave to start (P to A’start), to peak (P to A’peak) and to end of atrial deformation (total electromechanical activity). These intervals were compared to each other and to P-wave dispersion derived from the recorded ECGs.ResultsAll patients were in sinus rhythm during their postoperative assessment, but 11 patients presented episodes of AF within the first three postoperative days. Atrial electromechanical activation was earliest in the RA and latest in the lateral LA. In patients with AF, P-wave dispersion was significantly prolonged postoperatively (mean: +18.6 ms; 95% confidence interval (CI): 12.1–25.2 ms; p < 0.001) compared to non-AF patients (mean: -2.4 ms; CI: -6.6–1.9 ms). P dispersion was closely correlated to P to A’start intervals (from RA to LA lat.: preop.: rho = 0.74, postop.: rho = 0.87; p < 0.001). Prolonged right to left conduction interval was associated with an elevated risk for AF (from RA to LA lat.: odds ratio 1.13 (CI:1.03-1.24); p: 0.007.ConclusionDMI enabled detection of interatrial conduction disturbances in concordance to findings of prolonged postoperative P-wave dispersion. Equally effective to P-wave dispersion, this simple and reproducible tool might help to early identify the risk for postoperative AF, thus extending the informative value of routine postoperative echocardiography.

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Prediction of Atrial Fibrillation After Off-Pump Coronary Artery Bypass Grafting Using Preoperative Total Atrial Conduction Time Determined on Tissue Doppler Imaging

Abstract: PA-TDI duration was an independent predictor of POAF following OPCAB. Awareness of risk of POAF may lead to the prevention of POAF, a rapid response to POAF, shortened hospital stay, and improved prognosis.

Cited by 22 publications

References 30 publications

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

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

Efficacy of Cardiopulmonary Rehabilitation With Adaptive Servo-Ventilation in Patients Undergoing Off-Pump Coronary Artery Bypass Grafting

Interatrial conduction disturbance in postoperative atrial fibrillation: a comparative study of P-wave dispersion and Doppler myocardial imaging in cardiac surgery

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