Baseline Intraoperative Left Ventricular Diastolic Function Is Associated with Postoperative Atrial Fibrillation after Cardiac Surgery

Author:

Rong Lisa Q.1ORCID,Di Franco Antonino2,Rahouma Mohammed3,Dimagli Arnaldo4,Patel Aneri5,Lopes Alexandra J.6,Walline Maria7,Chan June8,Chadow David9,Olaria Roberto Perezgrovas10,Soletti Giovanni11,Kim Jiwon12,Devereux Richard B.13,Pryor Kane O.14,Girardi Leonard N.15,Weinsaft Jonathan W.16,Gaudino Mario17

Affiliation:

1. 1Department of Anesthesiology, Weill Cornell Medicine, New York, New York.

2. 2Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York.

3. 3Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York.

4. 4Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York.

5. 5Department of Anesthesiology, Weill Cornell Medicine, New York, New York.

6. 6Department of Anesthesiology, Weill Cornell Medicine, New York, New York.

7. 7Department of Anesthesiology, Weill Cornell Medicine, New York, New York.

8. 8Department of Anesthesiology, Weill Cornell Medicine, New York, New York.

9. 9Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York.

10. 10Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York.

11. 11Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York.

12. 12Department of Medicine, Division of Cardiology, Weill Cornell Medicine, New York, New York.

13. 13Department of Medicine, Division of Cardiology, Weill Cornell Medicine, New York, New York.

14. 14Department of Anesthesiology, Weill Cornell Medicine, New York, New York.

15. 15Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York.

16. 16Department of Medicine, Division of Cardiology, Weill Cornell Medicine, New York, New York.

17. 17Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York.

Abstract

Background Detailed understanding of the association between intraoperative left atrial and left ventricular diastolic function and postoperative atrial fibrillation is lacking. In this post hoc analysis of the Posterior Left Pericardiotomy for the Prevention of Atrial Fibrillation after Cardiac Surgery (PALACS) trial, we aimed to evaluate the association of intraoperative left atrial and left ventricular diastolic function as assessed by transesophageal echocardiography (TEE) with postoperative atrial fibrillation. Methods PALACS patients with available intraoperative TEE data (n = 402 of 420; 95.7%) were included in this cohort study. We tested the hypotheses that preoperative left atrial size and function, left ventricular diastolic function, and their intraoperative changes were associated with postoperative atrial fibrillation. Normal left ventricular diastolic function was graded as 0 and with lateral e’ velocity 10 cm/s or greater. Diastolic dysfunction was defined as lateral e’ less than 10 cm/s using E/e’ cutoffs of grade 1, E/e’ 8 or less; grade, 2 E/e’ 9 to 12; and grade 3, E/e’ 13 or greater, along with two criteria based on mitral inflow and pulmonary wave flow velocities. Results A total of 230 of 402 patients (57.2%) had intraoperative diastolic dysfunction. Posterior pericardiotomy intervention was not significantly different between the two groups. A total of 99 of 402 patients (24.6%) developed postoperative atrial fibrillation. Patients who developed postoperative atrial fibrillation more frequently had abnormal left ventricular diastolic function compared to patients who did not develop postoperative atrial fibrillation (75.0% [n = 161 of 303] vs. 57.5% [n = 69 of 99]; P = 0.004). Of the left atrial size and function parameters, only delta left atrial area, defined as presternotomy minus post–chest closure measurement, was significantly different in the no postoperative atrial fibrillation versus postoperative atrial fibrillation groups on univariate analysis (–2.1 cm2 [interquartile range, –5.1 to 1.0] vs. 0.1 [interquartile range, –4.0 to 4.8]; P = 0.028). At multivariable analysis, baseline abnormal left ventricular diastolic function (odds ratio, 2.02; 95% CI, 1.15 to 3.63; P = 0.016) and pericardiotomy intervention (odds ratio, 0.46; 95% CI, 0.27 to 0.78, P = 0.004) were the only covariates independently associated with postoperative atrial fibrillation. Conclusions Baseline preoperative left ventricular diastolic dysfunction on TEE, not left atrial size or function, is independently associated with postoperative atrial fibrillation. Further studies are needed to test if interventions aimed at optimizing intraoperative left ventricular diastolic function during cardiac surgery may reduce the risk of postoperative atrial fibrillation. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Anesthesiology and Pain Medicine

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