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

Abstract

Aims This systematic review and meta-analysis aims to evaluate the role of pre-operative transthoracic echocardiography in predicting post-operative atrial fibrillation (POAF) after cardiac surgery. Methods and results Electronic databases were searched for studies reporting on pre-operative echocardiographic predictors of POAF in PubMed, Cochrane library, and Embase. A meta-analysis of echocardiographic predictors of POAF that were identified by at least five different publications was performed. Forty-three publications were included in this systematic review. Echocardiographic predictors for POAF included surrogate parameters for total atrial conduction time (TACT), structural cardiac changes, and functional disturbances. Meta-analysis showed that prolonged pre-operative PA-TDI interval [5 studies, Cohen’s d = 1.4, 95% confidence interval (CI) 0.9–1.9], increased left atrial volume indexed for body surface area (LAVI) (23 studies, Cohen’s d = 0.8, 95% CI 0.6–1.0), and reduced peak atrial longitudinal strain (PALS) (5 studies, Cohen’s d = 1.4, 95% CI 1.0–1.8), were associated with POAF incidence. Left atrial volume indexed for body surface was the most important predicting factor in patients without a history of AF. These parameters remained important predictors of POAF in heterogeneous populations with variable age and comorbidities such as coronary artery disease and valvular disease. Conclusion This meta-analysis shows that increased TACT, increased LAVI, and reduced PALS are valuable parameters for predicting POAF in the early post-operative phase in a large variety of patients.

Preoperative P-wave parameters and risk of atrial fibrillation after cardiac surgery: a meta-analysis of 20 201 patients

“…The search generated 2627 results. Additional 6 records were identified by scanning the studies included in a previous meta-analysis [ 14 ]. After exclusion of duplicates, 2633 studies were screened on title and abstracts and 65 publications were deemed suitable for full-text evaluation.…”

“…Furthermore, epicardial mapping of patients without a history of AF undergoing cardiac surgery showed more complex propagation patterns in patients developing POAF as compared to patients without POAF [ 2 ]. Also, previous studies have demonstrated the predictive value of total atrial activation time, which is a parameter quantifying intra- and interatrial conduction disturbances, in predicting POAF in a variety of cardiac surgical patients [ 14 ].…”

Strain Echocardiography to Predict Postoperative Atrial Fibrillation

“…The relationship between echocardiographic alterations and the incidence of POAF has been recently reviewed by Kawczynski et al [66]. Table 3 summarizes the main results regarding echocardiographic atrial strain and POAF.…”

“…Numerous studies show that subclinical LA booster pump, conduit and reservoir function alterations determined by atrial strain are useful tools for risk stratification and prevention of POAF. A recent meta-analysis found that increased atrial size and reduced reservoir atrial function have a strong correlation with POAF incidence [66].…”

"Pathophysiology and Management of Atrial Fibrillation"

“…The re-entry mechanism is promoted by slow conduction velocity of the depolarizing wave front and a shortened refractory period of cardiac myocytes. The presence of structural and electrophysiological atrial abnormalities favors the selfperpetuation of AF by promoting re-entry [14].…”