Forschung & Innovation
Publikationen
Interatrial block is an independent risk factor for new-onset atrial fibrillation after cardiac surgery
PMU Autor*innen
Spela Leiler, Wolfgang Hitzl, Matthias Angerer, Theodor Fischlein, Jurij Matija Kalisnik
Alle Autor*innen
Spela Leiler, Andre Bauer, Wolfgang Hitzl, Rok Bernik, Valentin Guenzler, Matthias Angerer, Theodor Fischlein, Jurij Matija Kalisnik
Fachzeitschrift
JTCVS OPEN
Kurzfassung
Objectives: This study aims to investigate the association between interatrial conduction block and postoperative atrial fi brillation, which can precipitate acute cardiopulmonary instability and is associated with subsequent heart failure, stroke, and mortality following cardiac surgery.<br /> Methods: Perioperative 12-channel electrocardiograms from 3405 patients undergoing myocardial revascularization, valve surgery, aortic surgery, or combinations thereof, were considered. Clinical and electrographic parameters were compared between patients with and without atrial fi brillation, and significant variables were analyzed using univariate and multivariate logistic regression. Results: Among 2108 analyzed patients, 764 (36.2%) developed atrial fi brillation. Preoperative interatrial block was a strong independent risk factor (3.18; 95% CI, 2.55, 3.96; P < .001), significantly improving area under the receiver operator characteristics curve from 71.8% to 75.6% (Delong's test: P = .013). Other risk factors included advanced age (1.05; 95% CI, 1.03, 1.07; P < .001), female gender (1.86; 95% CI, 1.45, 2.38; P < .001), history of cardiogenic shock (1.44; 95% CI, 0.99, 2.09; P = .057), reduced left ventricular ejection fraction < 40 % (1.57; 95% CI, 1.06, 2.33; P = .024), cessation of preoperative b-blockers (1.17; 95% CI, 0.95, 1.46; P = .145), score for clinical prediction rules for estimating the risk of stroke in people with non-rheumatic atrial fi brillation (CHAS2DS2-VASc) and European System for Cardiac Operative Risk Evaluation II score (0.87; 95% CI, 0.79, 0.97; P = .01) and (1.04; 95% CI, 0.99, 1.11; P = .138), preexisting left bundle branch block (1.59; 95% CI, 0.92, 2.74; P = .097), cardiopulmonary bypass time (1.00; 95% CI, 1.00, 1.00; P = .049), bicaval cannulation (1.45; 95% CI, 0.88, 2.41; P = .035), cardiac surgery-associated acute kidney injury (3.19; 95% CI, 2.45, 4.15; P < .001), and postoperative atrioventricular block (1.20; 95% CI, 0.96, 1.51; P = .105), particularly Mobitz I (6.73; 95% CI, 1.98, 31.51; P = .005).<br /> Conclusions: Perioperative electrocardiogram-derived parameters, especially interatrial block, are associated with postoperative atrial fi brillation. Further research is needed to clarify the link between conduction abnormalities and postoperative atrial fi brillation, enabling targeted prophylactic therapies for high-risk patients.
Keywords
Cardiac surgery, Atrial fibrillation, Electrocar- diogram, Interatrial block