CARDIOVASCULAR JOURNAL OF AFRICA • Vol 23, No 1, February 2012
36
AFRICA
prediction of postoperative atrial fibrillation.
11,12
Prior to this,
Stafford
et al
. found that signal-averaged P-wave duration was a
better predictor of atrial fibrillation after coronary artery bypass
grafting (CABG) than standard echocardiographic criteria.
13
In
our study, we did not investigate any electrocardiographic param-
eters for prediction.
Transthoracic echocardiography is a useful technique for
the prediction of postoperative atrial fibrillation. In most of the
recent trials, left atrial size and left ventricular systolic func-
tion were easily obtained for the prediction.
13
Roshanali
et al.
investigated the importance of atrial electromechanical interval
using transthoracic tissue Doppler echocardiography, and found
it to be a valuable method for identifying patients vulnerable to
post-CABG atrial fibrillation.
14
Further clinical trials were neces-
sary for the prediction of postoperative atrial fibrillation using
tissue Doppler echocardiography.
15
Interatrial conduction time
can therefore be used for the prediction of postoperative atrial
fibrillation.
Fuenmayor
et al
. found a new method for measuring interatri-
al conduction time, using transthoracic echocardiography. They
simultaneously measured the time interval between the electro-
cardiographic P wave and the mitral a wave using transthoracic
Doppler echocardiography and compared this with another more
invasive method. They found similar results and concluded that
transthoracic Doppler echocardiography combined with surface
electrocardiography can be used for measuring the interatrial
conduction time with a similar accuracy as other more invasive
methods.
16
Transoesophageal echocardiography has not frequently been
used for the prediction of postoperative atrial fibrillation in
recent clinical trials. TEE was however found to be a useful
tool for measuring interatrial conduction time.
8
In the study by
Kinay
et al
., a correlation between the interatrial conduction
time and recurrence of atrial fibrillation was established. We
therefore concluded that intra-operative measurement of intera-
trial conduction time by TEE could predict postoperative atrial
fibrillation.
8,17
In this study we found a statistically significant interatrial
conduction delay in group 1. Increased interatrial conduction
time may result in postoperative atrial fibrillation and it can be
measured by intraoperative TEE.
Postoperative atrial fibrillation may prolong the hospitalisa-
tion period, particularly time in the intensive care unit, which
may increase the risk of postoperative complications such as
nosocomial infections. Using anti-arrhythmic agents for patients
with prolonged interatrial conduction time before postoperative
atrial fibrillation occurs could decrease the risk of postoperative
complications.
Conclusion
In this study we found that postoperative atrial fibrillation was
more frequent in patients with longer interatrial conduction
times. Measurement of interatrial conduction time by TEE may
be a valuable method for the prediction of postoperative atrial
fibrillation, and interatrial conduction delay is an important risk
factor. We need more studies to define the cut-off point for
interatrial conduction time.
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