ECHOCARDIOGRAPHIC PREDICTORS OF POSTOPERATIVE ATRIAL FIBRILLATION

Highlights

Postoperative atrial fibrillation is a common complication after heart surgery. In the presented study, the analysis of data of patients with postoperative atrial fibrillation (158 patients) compared with patients without arrhythmia revealed a statistically significant (p < 0.05) difference in the size of the left atrium, end-diastolic size of the left ventricle, the left ventricular ejection fraction, the wall thickness of the left ventricle, the value of systolic pressure in the pulmonary artery and significant regurgitation on the mitral the valve. A preoperative echocardiogram can help predict the development of arrhythmia in the postoperative period.

Abstract

Background. Postoperative atrial fibrillation is a common complication after heart surgery. The arrhythmia occurs more often during the first five days after surgery, with a peak between 24 and 72 hours, and rarely after the first week. A change in the deformation of the left atrium cavity is associated with atrial fibrosis and may predict the risk of developing a new AF.

Aim. To identify echocardiographic predictors of newly diagnosed postoperative atrial fibrillation in patients who underwent open-heart surgery for any indication.

Methods. The study included patients operated in the Cardiac Surgery Department No. 2 of the State Medical Research Institute-KKB No. 1 of Krasnodar in the period from January 1, 2020 to January 1, 2021. During the analyzed period of time, open heart surgery was performed in 1 503 patients, 158 of whom had newly diagnosed postoperative atrial fibrillation (10.5%).

Results. In the presented study, the analysis of data of patients with postoperative atrial fibrillation compared with patients without arrhythmia revealed a statistically significant (p < 0.05) difference in the size of the left atrium, end-diastolic size of the left ventricle, the left ventricular ejection fraction, the wall thickness of the left ventricle, the value of systolic pressure in the pulmonary artery and significant regurgitation on the mitral the valve

Conclusion. Echocardiography is currently the main non-invasive tool for the analysis of cardiac function in the preoperative setting of cardiovascular surgery. The use of known parameters such as left atrial size, end-diastolic pressure, left ventricular ejection fraction using tissue Doppler sonography is a sensitive marker of arrhythmia in the early postoperative period.

1. Conen D., Alonso-Coello P., Douketis J., Chan M.T.V., Kurz A., Sigamani A., Parlow J.L., Wang C.Y., et al. Risk of stroke and other adverse outcomes in patients with perioperative atrial fibrillation 1 year after non-cardiac surgery. J Eur Heart J. 2020;41:645–51. doi: 10.1093/eurheartj/ehz431.

2. Dave S., Nirgude A., Gujjar P., Sharma R. Incidence and risk factors for development of atrial fibrillation after cardiac surgery under cardiopulmonary bypass. Indian J Anaesth. 2018;62:887–91. doi: 10.4103/ija.IJA_6_18.

3. Omer S., Cornwell L.D., Bakshi A., Rachlin E., Preventza O., Rosengart T.K., Coselli J.S., LeMaire S.A., Petersen N.J., Pattakos G., Bakaeen F.G. Incidence, predictors, and impact of postoperative atrial fibrillation after coronary artery bypass grafting in military veterans. Tex Heart Inst J. 2016;43:397–403. doi: 10.14503/THIJ-15-5532.

4. Gumprecht J., Domek M., Lip G.Y.H., Shantsila A. Invited review: Hypertension and atrial fibrillation: Epidemiology, pathophysiology, and implications for management. J Hum Hypertens. 2019;33:824–36. doi: 10.1038/s41371-019-0279-7.

5. Weymann A., Popoy A.F., Sabashinikav A., Ali-Hasan-Al-Saegh S., Ryazanov M., Tse G., Mirhosseini S.J., Liu T., et al. Baseline and postoperative levels of C-reactive protein and interleukins as inflammatory predictors of atrial fibrillation following cardiac surgery: A systematic review and meta-analysis. Kardiol Pol. 2018;76:440–51. doi: 10.5603/KP.a2017.0242.

6. Pierri M.D., Crescenzi G., Zingaro C., D'Alfonso A., Capestro F., Scocco V., Brugia M., Torracca L. Prevention of atrial fibrillation and inflammatory response after on-pump coronary artery bypass using different statin dosages: A randomized, controlled trial. Gen Thorac Cardiovasc Surg. 2016;64:395–402. doi: 10.1007/s11748-016-0647-y.

7. Tsai Y.T., Lai C.H,. Loh S.H., Lin C.Y., Lin Y.C., Lee C.Y., Ke H.Y., Tsai C.S. Assessment of the risk factors and outcomes for postoperative atrial fibrillation patients undergoing isolated coronary artery bypass grafting. Acta Cardiol Sin. 2015;31:436–43. doi: 10.6515/acs20150609a.

8. Kawczynski M.J., Gilbers M., Van De Walle S., Schalla S., Crijns H.J., Maessen J.G., Schotten U., Maesen B., Bidar E. Role of pre-operative transthoracic echocardiography in predicting post-operative atrial fibrillation after cardiac surgery: A systematic review of the literature and meta-analysis. EP Eur. 2021;23:1731–1743. doi: 10.1093/europace/euab095.

9. Mandoli G.E., Pastore M.C., Benfari G., Bisleri G., Maccherini M., Lisi G., Cameli P., Lisi M., Dokollari A., Carrucola C., Vigna M., Montesi G., Valente S., Mondillo S., Cameli M. Left atrial strain as a pre-operative prognostic marker for patients with severe mitral regurgitation. Int. J. Cardiol. 2020;41:ehaa946.0054. doi: 10.1093/ehjci/ehaa946.0054.

10. Pessoa-Amorim G., Mancio J., Vouga L., Ribeiro J., Gama V., Bettencourt N., Fontes-Carvalho R. Impaired Left Atrial Strain as a Predictor of New-onset Atrial Fibrillation After Aortic Valve Replacement Independently of Left Atrial Size. Rev. Española Cardiol. 2017;71:466–476. doi: 10.1016/j.recesp.2017.09.020.

11. Sabry A.M., Mansour H.A.E., Abo El-azm T.H., Mostafa S.A., Zahid B.S. Echocardiographic predictors of atrial fibrillation after mitral valve replacement. Egypt. Hear. J. 2017;69:281–288. doi: 10.1016/j.ehj.2017.07.002.

12. Aksu U., Kalkan K., Gulcu O., Aksakal E., Öztürk M., Topcu S. The role of the right atrium in development of postoperative atrial fibrillation: A speckle tracking echocardiography study. J. Clin. Ultrasound. 2019;47:470–476. doi: 10.1002/jcu.22736.

13. Ciuffo L., Tao S., Gucuk Ipek E., Zghaib T., Balouch M., Lima J.A.C., Nazarian S., Spragg D.D., Marine J.E., Berger R.D., Calkins H., Ashikaga H. Intra-Atrial Dyssynchrony During Sinus Rhythm Predicts Recurrence After the First Catheter Ablation for Atrial Fibrillation. JACC Cardiovasc. Imaging. 2019;12:310–319. doi: 10.1016/j.jcmg.2017.11.028.

14. Osranek M., Fatema K., Qaddoura F., Al-Saileek A., Barnes M.E., Bailey K.R., Gersh B.J., Tsang T.S., Zehr K.J., Seward J.B. Left Atrial Volume Predicts the Risk of Atrial Fibrillation After Cardiac Surgery A Prospective Study. J. Am. Coll. Cardiol. 2006;48:779–786. doi: 10.1016/j.jacc.2006.03.054.

15. Bessissow A., Khan J., Devereaux P.J., Alvarez-Garcia J., Alonso-Coello P. Postoperative atrial fibrillation in non-cardiac and cardiac surgery: an overview. J Thromb Haemost. 2015;13 Suppl 1:S304-12. doi: 10.1111/jth.12974.

16. Lang R.M., Badano L.P., Mor-Avi V., Afilalo J., Armstrong A., Ernande L., Flachskampf F.A., Foster E., Goldstein S.A., Kuznetsova T., Lancellotti P., Muraru D., Picard M.H., Rietzschel E.R., Rudski L., Spencer K.T., Tsang W., Voigt J.U. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2015;28(1):1-39.e14. doi: 10.1016/j.echo.2014.10.003.

17. Pritchett A.M., Jacobsen S.J., Mahoney D.W., Rodeheffer R.J., Bailey K.R., Redfield M.M. Left atrial volume as an index of left atrial size: A population-based study. J Am Coll Cardiol. 2003;41:1036–43. doi: 10.1016/s0735-1097(02)02981-9.

18. Brecher O., Gulati H., Roistacher N., Zhang H., Shi W., Thaler H.T., Amar D. Preoperative echocardiographic indices of diastolic dysfunction and brain natriuretic peptide in predicting postoperative atrial fibrillation after noncardiac surgery. Anesth Analg. (2017) 124:1099–104. doi:10.1213/ANE.0000000000001471.

19. Ai D,. Lasala J., Mehran J.R., Xu G., Banchs J., Cata J.P. Preoperative echocardiographic parameters of diastolic dysfunction did not provide a predictive value for postoperative atrial fibrillation in lung and esophageal cancer surgery. J Cardiothorac Vasc Anesth. (2015) 29:1127–30. doi:10.1053/j.jvca.2015.01.012

20. Mărgulescu A.D., Nuñez-Garcia M., Alarcón F., Benito E.M., Enomoto N., Cozzari J., Chipa F., Fernandez H., Borras R., Guasch E., Butakoff C., Tolosana J.M., Arbelo E., Camara O., Mont L. Reproducibility and accuracy of late gadolinium enhancement cardiac magnetic resonance measurements for the detection of left atrial fibrosis in patients undergoing atrial fibrillation ablation procedures. Europace.2019;21:724–731. doi: 10.1093/europace/euy314.

21.