title: Use of intraoperative transesophageal echocardiography to predict atrial fibrillation after coronary artery bypass grafting.
abstract: BACKGROUND
  Postoperative atrial fibrillation in coronary artery bypass graft surgery occurs in 10-40% of patients. It is associated with a significant degree of morbidity and results in prolonged lengths of stay in both the intensive care unit and hospital.
  
  
  METHODS
  The authors prospectively evaluated patients undergoing coronary artery bypass with detailed transesophageal echocardiography examinations conducted before and after cardiopulmonary bypass to study whether risk factors for atrial fibrillation could be identified. Demographic and surgical parameters were also included in the analysis. Selected variables were subjected to univariate and subsequent multivariate analyses to test for their independent or joint influence on atrial fibrillation.
  
  
  RESULTS
  Seventy-nine patients had assessable transesophageal echocardiography examinations. Significant univariate predictors of atrial fibrillation included advanced age (P = 0.002), pre-cardiopulmonary bypass left atrial appendage area (P = 0.04), and post-cardiopulmonary bypass left upper pulmonary vein systole/diastole velocity ratio (P = 0.03). When these three factors were considered together in a multiple logistic regression analysis, left upper pulmonary vein systole/diastole velocity ratio was a significant predictor (P < 0.05), as was the joint effect of age plus pre-cardiopulmonary bypass left atrial appendage area (P = 0.005). The probability of developing atrial fibrillation for the combination of age = 75 yr, post-cardiopulmonary bypass left upper pulmonary vein systole/diastole velocity ratio = 0.5, and left atrial appendage area = 4.0 cm was 0.83 (95% confidence interval, 0.51-0.96).
  
  
  CONCLUSIONS
  Early identification of patients at risk for postoperative atrial fibrillation may be feasible using the parameters identified in this study.
authors.affiliation: Department of Anesthesiology, Mount Sinai Medical Center, New York, New York 10029, USA. linda.shore@mssm.edu
authors.forename: L
authors.initials: L
authors.lastname: Shore-Lesserson
authors.forename: D
authors.initials: D
authors.lastname: Moskowitz
authors.forename: C
authors.initials: C
authors.lastname: Hametz
authors.forename: D
authors.initials: D
authors.lastname: Andrews
authors.forename: T
authors.initials: T
authors.lastname: Yamada
authors.forename: F
authors.initials: F
authors.lastname: Vela-Cantos
authors.forename: S
authors.initials: S
authors.lastname: Hossain
authors.forename: C
authors.initials: C
authors.lastname: Bodian
authors.forename: R J
authors.initials: RJ
authors.lastname: Lessen
authors.forename: S N
authors.initials: SN
authors.lastname: Konstadt
mesh_terms: D000367:Age Factors; D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis*; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D017548:Echocardiography, Transesophageal; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D015999:Multivariate Analysis; D016277:Ventricular Function, Left