Preoperative left atrial dysfunction and risk of postoperative atrial fibrillation complicating thoracic surgery

Raman, Tina; Roistacher, Nancy; Liu, Jennifer; Zhang, Hao; Shi, Wei; Thaler, Howard T.; Amar, David

doi:10.1016/j.jtcvs.2011.08.025

Cited by 45 publications

(27 citation statements)

References 25 publications

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“…29 This study has a broad scope, including an analysis of pre-and intraoperative risk factors, all complications, the management and resolution of AF, and longer-term impact on oncologic outcomes. [32][33][34][35][36] It may be a plausible thesis that in predisposed patients, transthoracic and transmediastinal disruption of autonomic fibers, and direct trauma to the atrium and pulmonary veins, are enabling factors, as well as intra-and postoperative oxidative stress and inflammation. The type of operation, most notably 3-stage resection and TH surgery, compared with 2stage and an ETG, was associated with AF (P = 0.05), possibly reflecting greater disruption of the autonomic nervous system from the higher mediastinal dissection.…”

Section: Discussionmentioning

confidence: 99%

New-onset Atrial Fibrillation Post-surgery for Esophageal and Junctional Cancer

et al. 2014

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A total of 473 patients (mean age: 63 years; 73% male) underwent resection, 51% 2-stage, 18% 3-stage, 12% transhiatal, and 19% extended total gastrectomy. Ninety-six (20%) patients developed new-onset AF, in 18%, 27%, 29%, and 14% of 2-, 3-, transhiatal, and extended total gastrectomy cohorts, respectively (P=0.05). Age, diabetes, neoadjuvant therapy, and cardiac history predisposed (P<0.05) to AF, and AF was significantly (P<0.0001) associated with pneumonia, pleural effusions requiring drainage, and maximum postoperative C-reactive protein (CRP) (P<0.05) but not with anastomotic leak/conduit necrosis or mortality. Amiodarone was the primary treatment in 63% of cases, 1% underwent cardioversion, and 92% were in sinus rhythm on discharge. At a median follow-up of 40 months (7-109 months), the median survival was 40 months versus 53 months in the AF and non-AF cohorts, respectively (P=0.353) CONCLUSIONS: New-onset AF is common, linked to age, diabetes, cardiac disease, and neoadjuvant therapy. It is strongly associated with complications, principally respiratory sepsis, and systemic inflammation. For most, it resolves, with no impact on oncologic outcomes.

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Section: Discussionmentioning

confidence: 99%

New-onset Atrial Fibrillation Post-surgery for Esophageal and Junctional Cancer

et al. 2014

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“…On the other hand, the relationship between Vol min and LV diastolic function appears to be more direct, as in end‐diastole the mitral valve is open and the left atrium is directly exposed to the LV pressure. Thus, the LA expansion index was calculated as (Vol max – Vol min ) × 100%/Vol min , although the LA emptying fraction using Vol max as the denominator is useful for predicting post‐operative AF . Based on two reasons, the LA ejection fraction is also not well suited to assessing prognosis.…”

Section: Discussionmentioning

confidence: 99%

Left atrial expansion index predicts all‐cause mortality and heart failure admissions in dyspnoea

Hsiao

Chiou

2013

European J of Heart Fail

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AimsThe power of left atrial (LA) parameters for predicting adverse events in relatively low-risk groups is not fully understood. This study investigated whether the LA expansion index predicts heart failure (HF) and all-cause mortality in subjects with dyspnoea. Methods and resultsEchocardiography was performed to identify causes of dypnoea in 1735 patients. The LA expansion index was calculated as (Vol max -Vol min ) × 100%/Vol min , where Vol max was defined as the maximal LA volume and Vol min was defined as the minimal LA volume. The endpoints were 2-year frequencies of HF hospitalization and all-cause mortality. Over a median follow-up of 2.7 years, 91 participants reached endpoints. Rates of adverse events were exponentially proportional to the LA expansion index. For predicting adverse events, the LA expansion index was better than the maximal indexed LA volume and tissue Doppler parameters. Hospitalization for HF was independently associated with age, LVEF, pulmonary artery systolic pressure, LA expansion index, and history of prior HF. All-cause mortality was associated with age, pulmonary artery systolic pressure, and LA expansion index. Compared with the highest quartile of the LA expansion index, the lowest quartile had a 3.1-fold higher hazard of HF events and a 17.8-fold higher hazard of all-cause mortality. ConclusionsThe LA expansion index predicts adverse events in patients with dyspnoea. The prognostic power of the index exceeds that of other well-established echocardiographic parameters such as E/e' and maximal indexed LA volume.

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“…Additionally, increased levels of b-type natriuretic peptide (BNP), which has been shown to confer a significant risk for POAF, is associated with diastolic dysfunction and a subsequent enlarged left atrium, independent of signs or symptoms of cardiac dysfunction. (24, 25) We were unable to adjust our results for preoperative levels of BNP, which was only collected if a patient manifested fluid overload. However, our multivariable analysis was adjusted for unstable heart failure.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Risk of Atrial Fibrillation in Black Versus White Patients After Coronary Artery Bypass Grafting

Efird

Gudimella

O’Neal

et al. 2016

The American Journal of Cardiology

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Obesity has been identified as a risk factor for postoperative atrial fibrillation (POAF) following coronary artery bypass grafting (CABG). However, no studies have addressed the influence of race on this association. A total of 13,594 patients undergoing first-time, isolated CABG without preoperative atrial fibrillation between 1992 and 2011 were included in our study. The association between body mass index (BMI) and POAF was compared by race. Relative risk and 95% confidence intervals were computed using maximum likelihood log-binomial regression. Increasing levels of BMI were associated with higher POAF risk following CABG among black but not white patients (Pinteraction=0.0009).

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Preoperative left atrial dysfunction and risk of postoperative atrial fibrillation complicating thoracic surgery

Cited by 45 publications

References 25 publications

New-onset Atrial Fibrillation Post-surgery for Esophageal and Junctional Cancer

New-onset Atrial Fibrillation Post-surgery for Esophageal and Junctional Cancer

Left atrial expansion index predicts all‐cause mortality and heart failure admissions in dyspnoea

Comparison of Risk of Atrial Fibrillation in Black Versus White Patients After Coronary Artery Bypass Grafting

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