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CLINICAL RESEARCH: CARDIAC IMAGING

Left Atrial Volume Predicts the Risk of Atrial Fibrillation After Cardiac Surgery

A Prospective Study

Martin Osranek, MD, MSc^_*,_*, Kaniz Fatema, MD, PhD^_*, Fatema Qaddoura, MD^_*, Ahmed Al-Saileek, MD^_*, Marion E. Barnes, MSc^_*, Kent R. Bailey, PhD, Bernard J. Gersh, MB, ChB, DPhil, FACC^_*, Teresa S.M. Tsang, MD, FACC^_*, Kenton J. Zehr, MD and James B. Seward, MD, FACC^_*

^_* Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
Division of Biostatistics, Mayo Clinic, Rochester, Minnesota.
Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota.

Manuscript received December 12, 2005; revised manuscript received March 17, 2006, accepted March 21, 2006.

^_* Reprint requests and correspondence: Dr. Martin Osranek, Division of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905. (Email: osranek.martin{at}mayo.edu).

OBJECTIVES: This study sought to identify preoperative predictors of postoperative atrial fibrillation (POAF) among patients undergoing cardiac surgery.

BACKGROUND: Postoperative atrial fibrillation is frequent after cardiac surgery and is associated with increased morbidity, mortality, prolonged hospital stay, and increased costs. Left atrial volume (LAV), a marker of chronically elevated left ventricular filling pressure, is a predictor of atrial fibrillation (AF) in the nonsurgical setting.

METHODS: A total of 205 patients (mean age 62 ± 16 years; 35% women) undergoing cardiac surgery were prospectively enrolled. Clinical risk factors were obtained by detailed medical record review and patient interview. Preoperative transthoracic echocardiograms were performed for assessment of LAV, left ventricular ejection fraction, and diastolic function. Follow-up was complete. Detection of POAF was based on documentation of AF episodes by continuous telemetry throughout hospitalization.

RESULTS: Postoperative atrial fibrillation occurred in 84 patients (41.4%) at a median of 1.8 days after cardiac surgery. The LAV was significantly larger in patients in whom AF developed (49 ± 14 ml/m² vs. 39 ± 16 ml/m², p = 0.0001). Patients with LAV >32 ml/m² had an almost five-fold increased risk of POAF, independently of age and clinical risk factors (adjusted hazard ratio 4.84, 95% confidence interval 1.93 to 12.17, p = 0.001). Age and LAV were the only independent predictors of POAF. The area under the receiver-operator characteristics curve to predict POAF was 0.729 for LAV and 0.768 for the combination of LAV and age (both p < 0.0001).

CONCLUSIONS: The LAV is a strong and independent predictor of POAF. Risk stratification using LAV and age enables clinicians to identify high-risk patients before cardiac surgery.

Abbreviations and Acronyms   CABG = coronary artery bypass graft   CI = confidence interval   DFG = diastolic function grade   EF = ejection fraction   HR = hazard ratio   LAV = left atrial volume   POAF = postoperative atrial fibrillation

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