Prediction of Atrial Fibrillation After Off-Pump Coronary Artery Bypass Grafting Using Preoperative Total Atrial Conduction Time Determined on Tissue Doppler Imaging

組織ドッブラー法を用いた体外循環非使用冠動脈バイパス手術の術後心房細動の発症予測

Fujiwara Mai

Background: Postoperative atrial fibrillation (POAF) is a common complication of cardiac surgery and results in increased health-care utilization. This study identified new transthoracic echocardiographic predictors of POAF using an index of the total atrial conduction time derived on tissue Doppler imaging (PA-TDI duration) in patients undergoing off-pump coronary artery bypass grafting (OPCAB).

Methods and Results: A total of 88 patients undergoing isolated OPCAB were enrolled. They were examined preoperatively on transthoracic echocardiography with tissue Doppler evaluations and monitored postoperatively with continuous electrocardiographic telemetry for 7 days. POAF occurred in 35 patients (39.8%). Patients with POAF had a significantly longer duration of hospital stay than those without (44.9±6.2 vs. 37.3±3.3 days, P=0.04). Multivariate analysis showed that PA-TDI duration (odds ratio [OR], 1.11; 95% confidence interval [CI]: 1.06-1.16; P=0.0001) and left atrial volume index (LAVI; OR, 1.11; 95% CI: 1.02-1.20; P=0.01) were independent predictors of POAF. Moreover, PA-TDI duration was more reliable, given an area under the receiver operating characteristic curve of 0.85 (sensitivity, 74.3%; specificity, 86.8%).

Conclusions: PA-TDI duration was an independent predictor of POAF following OPCAB. Awareness of risk of POAF may lead to the prevention of POAF, a rapid response to POAF, shortened hospital stay, and improved prognosis.

Atrial fibrillation

Off-pump coronary artery bypass grafting

PA-TDI duration

Medical sciences [ 490 ]

eng

Copyright(c) by Author

[Created] 2014-11-21

Mai Fujiwara, Yukiko Nakano, Takayuki Hidaka, Noboru Oda, Yuko Uchimura, Akinori Sairaku, Kenta Kajihara, Takehito Tokuyama, Chikaaki Motoda, Yoshikazu Watanabe, Hiroki Ikenaga, Katsuhiko Imai, Taijirou Sueda and Yasuki Kihara; Prediction of Atrial Fibrillation After Off-Pump Coronary Artery Bypass Grafting Using Preoperative Total Atrial Conduction Time Determined on Tissue Doppler Imaging; Circulation Journal Vol.78, February 2014 (doi: 10.1253/circj.CJ-13-0900) references

[DOI] http://dx.doi.org/10.1253/circj.CJ-13-0900 references

広島大学