CARDIOVASCULAR JOURNAL OF AFRICA • Vol 23, No 1, February 2012
34
AFRICA
Prediction of early postoperative atrial fibrillation after
cardiac surgery: is it possible?
The value of interatrial conduction time for the prediction of early postoperative
atrial fibrillation using intra-operative transoesophageal echocardiography
M KARACA, MI DEMIRBAS, S BICEROGLU, A ÇEVIK, Y CETIN, M ARPAZ, H YILMAZ
Abstract
Background:
Postoperative atrial fibrillation is common
after cardiac surgery. In this study, we aimed to investigate
the value of interatrial conduction time for the prediction of
early postoperative atrial fibrillation, using intra-operative
transoesophageal echocardiography.
Methods:
A total of 65 patients undergoing cardiac surgery in
our hospital between January and March 2007 were prospec-
tively evaluated, and 59 patients with sinus rhythm were
included in the study. We performed transoesophageal echo-
cardiography on all patients, and intra-operatively measured
the interatrial conduction time, as recently described. The
patients with episodes of atrial fibrillation during the post-
surgery hospitalisation period were defined as group 1 and
those without episodes were defined as group 2.
Results:
Mean interatrial conduction time was 74
±
15.9 ms
in group 1 and 54
±
7.9 ms in group 2. The difference in inter-
atrial conduction time between the two groups was statisti-
cally significant (
p
<
0.05). In this study we found a statisti-
cally significant interatrial conduction delay between the
groups. Postoperative atrial fibrillation was more frequent in
patients with a longer interatrial conduction time.
Conclusion:
Increased interatrial conduction time may cause
postoperative atrial fibrillation and it can be measured intra-
operatively by transoesophageal echocardiography.
Keywords:
atrial fibrillation, interatrial conduction time, cardiac
surgery, transoesophageal echocardiography
Submitted 20/1/11, accepted 16/2/11
Cardiovasc J Afr
2012;
23
: 34–36
DOI: 10.5830/CVJA-2011-010
Postoperative atrial fibrillation is a frequent complication,
occurring in 30 to 50% of patients after cardiac surgery.
1
It is
associated with an increased risk of morbidity and mortality, it
predisposes patients to a higher risk of stroke, requires additional
treatment, and increases the costs of postoperative care.
2,3
There are many clinical risk factors for developing postopera-
tive atrial fibrillation, including age, gender, obesity, hyperten-
sion, diabetes mellitus, low left ventricular ejection fraction,
hypoxia, chronic pulmonary lung disease, and left atrial size and
diameter.
4,5
In the study by Straus
et al
., important peri-operative
factors for the development of atrial fibrillation were: longer
extracorporeal circulation, increased dose/number of inotropic
drugs, blood transfusion, and elevated postoperative white blood
cell count.
6
Prolonged interatrial conduction time has been reported in
patients with paroxysmal atrial fibrillation.
7
Interatrial conduc-
tion delay may be an important parameter for the development of
atrial fibrillation after cardiac surgery and it can be measured as
accurately by transoesophageal echocardiography as by invasive
electrophysiological methods.
8
The prediction of atrial fibrillation may reduce postoperative
complications and hospitalisation time after cardiac surgery.
Previously published studies investigating the value of echocar-
diography or electrocardiography (ECG) for the prediction of
postoperative atrial fibrillation indicate the need for other meth-
ods to predict early postoperative atrial fibrillation.
In this study, we aimed to investigate the value of interatrial
conduction time for the prediction of early postoperative atrial
fibrillation using intra-operative transoesophageal echocardiog-
raphy (TEE).
Methods
Sixty-five patients undergoing cardiac surgery in our hospital
between January and March 2007 were prospectively evaluated.
Patients in sinus rhythm and with no known history of episodes
of atrial fibrillation before surgery were included in the study.
Patients were followed for the occurrence of atrial fibrillation
during the hospitalisation period. We collected the clinical data
with the permission of the local ethics committee.
All clinical characteristics of patients were noted (hyperten-
sion, diabetes mellitus, age, gender, indications for surgery, etc).
After discharge from the postoperative care unit, all patients
were followed for the occurrence of episodes of atrial fibrilla-
tion using ECG holter monitoring, which was performed for all
patients until discharge from hospital.
Transthoracic echocardiography was performed in all patients
before surgery. Left ventricular function was evaluated and the
diameters of the cardiac chambers were measured. The diam-
eters of the left ventricle and left atrium were measured from the
parasternal short-axis view. The left ventricular ejection fraction
Department of Cardiology, Atakalp Heart Hospital, Izmir,
Turkey
M KARACA, MD
MI DEMIRBAS, MD,
S BICEROGLU, MD
H YILMAZ, MD
Department of Anesthesia, Atakalp Heart Hospital, Izmir,
Turkey
A ÇEVIK, MD
Y CETIN, MD
Department of Cardiovascular Surgery, Atakalp Heart
Hospital, Izmir, Turkey
MURAT ARPAZ, MD
