Resting heart rate as a preoperative predictor of postoperative atrial fibrillation after pulmonary thromboendarterectomy

Abstract

Background As a marker of the autonomic nervous system, resting heart rate is a predictor of postoperative atrial fibrillation (POAF). However, its predictive value for POAF after pulmonary thromboendarterectomy (PTE) has not been adequately studied. Methods We enrolled 97 patients who underwent PTE in our hospital from December 2016 to November 2021 in this retrospective study. Almost all preoperative characteristics, including electrocardiogram, demographics, hematologic and biochemical indices, echocardiography, and pulmonary hemodynamics, were compared between patients with and without POAF. Multivariate logistic regression analysis was used to identify the independent risk factors for POAF after PTE. Results Overall, 21 patients (21.6%) suffered from POAF after PTE. Compared with patients without POAF, those with POAF were older (p = .049), with a higher resting heart rate (p = .012), and higher platelet count (p = .040). In the binary logistic regression analysis, the resting heart rate (odds ratio [OR] = 1.043, 95% confidence interval [CI] = 1.009–1.078, p = .012) and age (OR = 1.051, 95% CI = 1.003–1.102, p = .037) were independent risk factors for POAF after PTE. The optimal cutoff point of resting heart rate was 89.5 with sensitivity and specificity of 47.6% and 77.6%. When the cutoff value of the age was 54.5, its sensitivity for predicting POAF was 71.4%, with a specificity of 59.2%. Conclusions POAF is common after PTE surgery, and the incidence may be underestimated. The resting heart rate and age are independent preoperative risk factors for POAF after PTE. Considering the lower predictive power of the resting heart and age, further large‐scale studies are needed.

Preoperative predictors of postoperative atrial fibrillation in patients undergoing cardiopulmonary bypass

“…The development of PoAF can be affected by preoperative RHR, as demonstrated in this study by Liu et al 3 RHR is a marker of the autonomic nervous system. After autonomic activation, beta adrenergic stimulation can develop and PoAF can be triggered 9 .…”

“…In this study, which included 97 patients, PoAF developed in 21 (21.6%) patients, and they showed preoperative RHR as an independent predictor of PoAF (odds ratio [OR] = 1.043, 95% confidence interval [CI]: 1.009–1.078, p = .012). However, this result had low predictive power (sensitivity: 47.6%, specificity: 77.6%) 3 …”

“…Therefore, this situation reduces the value of the studies. Liu et al 3 have been increased the importance of their studies by performing continuous ECG monitoring in the postoperative period.…”

“…In patients undergoing PTE, postoperative complications including pleural effusion, bleeding, atrial arrhythmias and wound infection are similar to other cardiac surgery interventions. In this issue of the Journal of Cardiac Surgery , in a retrospective study by Liu et al, 3 the impact of preoperative resting heart rate (RHR) on PoAF was investigated in patients who underwent elective PTE surgery for CTEPH. In this study, which included 97 patients, PoAF developed in 21 (21.6%) patients, and they showed preoperative RHR as an independent predictor of PoAF (odds ratio [OR] = 1.043, 95% confidence interval [CI]: 1.009–1.078, p = .012).…”

Implication to predict postoperative atrial fibrillation following pulmonary thromboendarterectomy

“…To the Editor, Liu and colleagues demonstrated that the development of postoperative atrial fibrillation (POAF) was not rare after pulmonary thromboendarterectomy (PTE), and the resting heart rate and age were their preoperative predictors. 1 Several concerns have been raised.…”