Document Detail


Impairment of left atrial function predicts post-operative atrial fibrillation after coronary artery bypass graft surgery.
MedLine Citation:
PMID:  15474699     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
AIMS: Despite the prevalence of atrial fibrillation (AF) occurring after cardiac surgery, its pathophysiology is incompletely understood. Specifically, whether left atrial (LA) structural remodelling occurs, contributing to a decrement in atrial function and AF has not been previously determined. This study sought to determine the relationship between LA function and post-operative AF. METHODS AND RESULTS: Three hundred patients undergoing elective coronary artery bypass graft surgery were monitored with intraoperative transoesophageal echocardiography to determine LA function and dimensions. Post-operative AF was monitored with continuous telemetry until hospital discharge. The relationship between clinical factors versus LA function and dimension was assessed using multi-variate logistic regression. By univariate analysis, patients who subsequently developed post-operative AF had a larger LA area and LA appendage area, and lower LA ejection fraction measured in the pre-bypass period compared to those without subsequent AF. By multivariable analysis, in addition to clinical data including age (odds ratio [OR] 1.11, 95% confidence interval [CI] 1.05-1.16, P<0.0001), body surface area (OR 13.31, 95% CI 1.87-94.5, P=0.0097) and white race, post-bypass atrial systolic function (atrial filling fraction 0.36, OR 2.51, 95% CI 1.03-6.13, P=0.04) and abnormal relaxation of the left ventricle (E duration 270 ms) (OR 2.89, 95% CI 1.34-6.24, P=0.0067) independently increased the risk of post-operative AF. CONCLUSION: These results demonstrate that some of the structural and functional changes in the atria common to chronic AF in the elderly population are also prevalent in surgical patients who develop post-operative AF, suggesting that post-operative and chronic AF may have similar pathophysiology.
Authors:
Jacqueline M Leung; Wayne H Bellows; Nelson B Schiller
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Publication Detail:
Type:  Journal Article; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  European heart journal     Volume:  25     ISSN:  0195-668X     ISO Abbreviation:  Eur. Heart J.     Publication Date:  2004 Oct 
Date Detail:
Created Date:  2004-10-11     Completed Date:  2005-03-03     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  8006263     Medline TA:  Eur Heart J     Country:  England    
Other Details:
Languages:  eng     Pagination:  1836-44     Citation Subset:  IM    
Affiliation:
Department of Anesthesia and Perioperative Care, University of California, 521 Parnassus Avenue, San Francisco, CA 94143-0648, USA. jmleung@itsa.ucsf.edu
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MeSH Terms
Descriptor/Qualifier:
Atrial Fibrillation / etiology*,  physiopathology
Atrial Function, Left / physiology*
Coronary Artery Bypass*
Coronary Disease / physiopathology,  surgery*
Echocardiography, Transesophageal
Female
Hemodynamics / physiology
Humans
Intraoperative Care / methods
Male
Middle Aged
Postoperative Complications / etiology*,  physiopathology
Regression Analysis
Treatment Outcome
Grant Support
ID/Acronym/Agency:
1K24AG00948/AG/NIA NIH HHS

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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