Document Detail


Preoperative left atrial dysfunction and risk of postoperative atrial fibrillation complicating thoracic surgery.
MedLine Citation:
PMID:  21955478     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
OBJECTIVE: Postoperative atrial fibrillation complicating general thoracic surgery increases morbidity and stroke risk. We aimed to determine whether preoperative atrial dysfunction or other echocardiographic markers are associated with postoperative atrial fibrillation. METHODS: In 191 patients who had undergone anatomic lung or esophageal resection, preoperative clinical and echocardiographic data were compared between patients with and without postoperative atrial fibrillation. Presence of postoperative atrial fibrillation lasting more than 5 minutes during hospitalization was detected using continuous telemetry or 12-lead electrocardiography. Maximal left atrial volume and indices of left atrial function were assessed. RESULTS: Patients with postoperative atrial fibrillation (33/191, 17%) were older (71 ± 5 years vs 64 ± 12 years, P < .0001), were taking β-blockers more often, had greater left atrial volume, had decreased left atrial emptying fraction, and had lower E' and A' septal velocities compared with patients without postoperative atrial fibrillation. The incidence of postoperative atrial fibrillation in patients with left atrial volume 32 mL/m(2) or greater was 37% (11/30) and greater than in those with left atrial volume less than 32 mL/m(2) (14%, 22/160, P = .002). Length of hospital stay was significantly increased in patients with postoperative atrial fibrillation compared with patients without (P = .04). Older age was significantly associated with greater β-blocker use and left atrial volume and lower left atrial emptying fraction. On multivariate analysis, lower left atrial emptying fraction (odds ratio, 1.03 per unit decrement; 95% confidence interval, 1.002-1.065; P = .04) and preoperative use of β-blockers (odds ratio, 2.82; 95% confidence interval, 1.18-6.77; P = .02) were the only independent risk factors associated with postoperative atrial fibrillation. CONCLUSIONS: These data show that an echocardiogram before major thoracic surgery, increased use of preoperative β-blockers, and decreased left atrial emptying fraction were associated with postoperative atrial fibrillation. Echocardiographic predictors of left atrial mechanical dysfunction may prove clinically useful in risk stratifying patients in whom postoperative atrial fibrillation is more likely to develop and to benefit from prevention strategies aimed at mitigating atrial function before surgery.
Authors:
Tina Raman; Nancy Roistacher; Jennifer Liu; Hao Zhang; Weiji Shi; Howard T Thaler; David Amar
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-9-26
Journal Detail:
Title:  The Journal of thoracic and cardiovascular surgery     Volume:  -     ISSN:  1097-685X     ISO Abbreviation:  -     Publication Date:  2011 Sep 
Date Detail:
Created Date:  2011-9-29     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0376343     Medline TA:  J Thorac Cardiovasc Surg     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2011 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.
Affiliation:
Department of Anesthesiology and Critical Care Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY.
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