Cardiovascular Journal of Africa: Vol 26 No 3 (May/June 2015)

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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 26, No 3, May/June 2015 120 AFRICA
Postoperative atrial fibrillation in patients with left atrial
myxoma
Muslum Sahin, Kursat Tigen, Cihan Dundar, Beste Ozben, Gokhan Alici, Serdar Demir,
Mehmet Emin Kalkan, Birol Ozkan
Abstract
Introduction: The aim of this study was to determine the
factors associated with postoperative atrial fibrillation (AF)
in patients with left atrial (LA) myxoma.
Methods: Thirty-six consecutive patients with LA myxoma
(10 men, mean age: 49.3 ± 15.7 years), who were operated
on between March 2010 and July 2012, were included in this
retrospective study. Pre-operative electrocardiograms and echo-
cardiographic examinations of each patient were reviewed.
Results: Postoperative AF developed in 10 patients, whereas
there was no evidence of paroxysmal AF after resection of the
LA myxoma in the remaining 26 patients. The patients who
developed AF postoperatively were significantly older than
those who did not develop AF (median: 61.5 vs 46 years; p
= 0.009). Among the electrocardiographic parameters, only
P-wave dispersion differed significantly between postopera-
tive AF and non-AF patients (median: 57.6 vs 39.8 ms, p =
0.004). Logistic regression analysis revealed P-wave dispersion
(OR: 1.11, 95% CI: 1.003–1.224, p = 0.043) and age (OR: 1.13,
95% CI: 1.001–1.278, p = 0.048) as independent predictors of
postoperative AF in our cohort of patients.
Conclusions: P-wave dispersion is a simple and useful param-
eter for the prediction of postoperative AF in patients with
LA myxoma.
Keywords: atrial fibrillation, left atrium, myxoma, postoperative,
P-wave dispersion
Submitted 5/5/13, accepted 27/11/14
Cardiovasc J Afr 2015; 26: 120–124
DOI: 10.5830/CVJA-2014-069
Paroxysmal atrial fibrillation (AF) is the most common
arrhythmia following cardiac surgery such as coronary artery
bypass grafting (CABG), and often occurs between the second
and fourth postoperative days.1,2 The reported incidence of
paroxysmal AF after CABG surgery varies widely, from five to
40%, which is lower than in cases of valvular cardiac surgery.3,4
Although this arrhythmia is usually benign and self-limiting,
it may also be associated with increased risk of embolic
events, haemodynamic instability, haemorrhagic complications,
prolonged hospital stay and higher rates of re-admissions,
increasing the healthcare costs.5-7
Several risk factors have been proposed for paroxysmal AF
after CABG or valvular cardiac surgery, such as advanced
age, genetic predisposition, chronic obstructive pulmonary
disease, heart failure or increased peri-operative ischaemia.8-10
In addition, certain echocardiographic parameters such as
left atrial (LA) diameter or left ventricular (LV) function, and
electrocardiographic parameters including P-wave duration and
P-wave dispersion (Pd) have been shown to be associated with
postoperative AF. 11-13
Although postoperative AF and its predictors after CABG
and valvular surgery have been well researched, no study
has been performed to explore the incidence or predictors of
postoperative AF in patients with LA myxoma. The aim of
this study was to identify the prevalence and predictors of
postoperative AF in a pure cohort of patients with LA myxoma.
Methods
This study complies with the principles outlined in the
Declaration of Helsinki. The study was approved by the local
ethics committee and all participants gave written informed
consent to participate in the study.
The electrocardiograms and echocardiographic recordings of
the 44 consecutive patients with LA myxoma who underwent
its excision in our centre between March 2000 and July 2012
were evaluated retrospectively. Previous history of AF or atrial
flutter, use of anti-arrhythmic drugs other than beta-blockers,
concomitant valvular disease other than mild mitral regurgitation,
symptomatic heart failure, renal disease, thyroid disorders, chronic
obstructive pulmonary disease, and presence of an implanted
pacemaker were exclusion criteria. Patients who had undergone
any surgery other than excision of a LA myxoma, including
CABG, had sustained ventricular tachyarrhythmia or cardiogenic
shock or died in the operating room were also excluded.
All medical records including standard pre-operative 12-lead
electrocardiograms (ECG), transthoracic echocardiography,
laboratory tests and blood pressure measurements were carefully
checked and documented. All patients were in sinus rhythm
before surgical excision of the tumour and their cardiac rhythms
were followed continuously during their stay in the intensive care
unit for at least for 48 hours by direct rhythm monitoring.
After discharge from the intensive care unit, the patients
were followed up with daily ECGs and rhythm evaluation
after complaints of palpitations, to diagnose any episodes of
paroxysmal AF. All patients were re-evaluated three months
Department of Cardiology, Kartal Kosuyolu Heart
Education and Research Hospital, Istanbul, Turkey
Muslum Sahin, MD,
Cihan Dundar, MD
Gokhan Alici, MD
Serdar Demir, MD
Mehmet Emin Kalkan, MD
Birol Ozkan, MD
Department of Cardiology, Marmara University School of
Medicine, Istanbul, Turkey
Kursat Tigen, MD
Beste Ozben, MD