Coronary Artery Disease
Usefulness of Right Ventricular Dysfunction to Predict New-Onset Atrial Fibrillation Following Coronary Artery Bypass Grafting

https://doi.org/10.1016/j.amjcard.2013.11.048Get rights and content

Postoperative atrial fibrillation (AF) is a serious yet common complication after coronary artery bypass grafting (CABG) surgery. Risk factors for postoperative AF have been identified, including echocardiographic parameters, and these are relied on to implement preventative strategies that reduce the incidence of AF. There has yet to be a study examining the impact of echocardiographic right-sided cardiac parameters on the prediction of postoperative AF. Thus, a panel of right-sided cardiac parameters was measured in a cohort of patients undergoing isolated CABG surgery, excluding those who did not have echocardiographic assessment within 30 days before surgery and those with any history of AF. The primary outcome was postoperative AF defined as any episode of AF requiring treatment during the index hospitalization. Postoperative AF occurred in 197 of 768 patients (25.6%); these were older and more likely to have hypertension and chronic kidney disease. After adjustment for clinical and echocardiographic variables, left atrial volume index ≥34 ml/m2 (odds ratio [OR] 1.98, 95% confidence interval [CI] 1.36 to 2.87), abnormal right ventricular myocardial performance index (OR 1.50, 95% CI 1.01 to 2.24), and advancing age (OR 1.05, 95% CI 1.03 to 1.07) were found to be independent predictors of postoperative AF. In conclusion, right ventricular myocardial performance index is a novel predictor of postoperative AF in patients undergoing isolated CABG surgery and appears to be additive to established risk factors such as age and left atrial volume.

Section snippets

Methods

Consecutive patients undergoing isolated CABG surgery without concomitant repair or replacement of the heart valves or great vessels were identified within the POSSE database. Data were obtained from 2 university-affiliated hospitals in the United States (Massachusetts General Hospital, Boston, Massachusetts, January 1, 2007 to December 31, 2009) and Canada (Jewish General Hospital, Montreal, Quebec, September 1, 2010 to July 11, 2011). From this cohort, subjects who had a digitally available

Results

The study population consisted of 768 patients (21.6% women), of which 197 patients (25.6%) developed postoperative AF. No patient was lost to follow-up for the primary outcome measure. Patients who developed postoperative AF were older (mean age 71.3 vs 64.9 years, p <0.001) and had a significantly higher rate of hypertension, chronic kidney disease, and congestive heart failure. They had slightly more number of diseased vessels and longer cardiopulmonary bypass times than patients without

Discussion

The present study has demonstrated that echocardiographic RV performance is predictive of postoperative AF in patients undergoing isolated CABG surgery. In particular, RV MPI, a composite measure of RV systolic and diastolic function, was additive to traditional risk factors for predicting postoperative AF.3 AF is one of the most commonly occurring arrhythmias after cardiac surgery and is associated with significant morbidity and mortality.8 In the general population, the pathophysiology of AF

Acknowledgment

We thank Marcia Leavitt, BA, David Crowell, BA, and Karen Lynch, BSN, for their invaluable help in obtaining clinical and echocardiographic data for this study. We also thank all of the cardiac sonographers at the Massachusetts General Hospital and Jewish General Hospital for their excellence in acquiring the echocardiographic images that made this study possible.

References (30)

Cited by (17)

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    2020, Intensive and Critical Care Nursing
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    Amongst them, five studies included only patients undergoing first time CABG surgery (Daie et al., 2018; Erdil et al., 2014; Leal et al., 2012; Mendes et al., 1995; Straus et al., 2010) and two studies included patients undergoing both first and re-do CABG surgeries (Perrier et al., 2017; Sedrakyan et al., 2006). The remaining three studies (Sabzi et al., 2011; Shimony et al., 2014; Vlahou et al.,2016) did not clearly identify the participant surgical histories. The incidence data for each study is summarised in Table 2.

  • Relationship Between Right Ventricular Function and Atrial Fibrillation After Cardiac Surgery

    2017, Journal of Cardiothoracic and Vascular Anesthesia
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    Similarly, preexisting multiple clinical morbidities and symptomatic heart failure due to increased atrial pressure and volume overload or chronic neurohumoral stimulation, which cause chronic and progressive remodeling processes of the heart, have been reported as predisposing factors that might trigger POAF or enhance the substrates sustaining the arrhythmia.13–15 Despite different risk factors identified for the development of POAF after cardiac surgery, associations with these risk factors showed a large discrepancy among different studies.5,8,15,16 For example, body mass index was found to be an important determinant of POAF, whereas other studies, including the study presented here, failed to show this.15

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Drs. Shimony and Afilalo contributed equally to this study.

This work was conducted with support from Harvard Catalyst, The Harvard Clinical and Translational Science Center (National Institutes of Health Award UL1 RR 025758 and financial contributions from Harvard University and its affiliated academic health care centers). The content is solely the responsibility of the authors and does not necessarily represent the official views of Harvard Catalyst, Harvard University and its affiliated academic health care centers, the National Center for Research Resources, or the National Institutes of Health (Boston, Massachusetts).

See page 917 for disclosure information.

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