title: Diastolic dysfunction in patients undergoing cardiac surgery: a pathophysiological mechanism underlying the initiation of new-onset post-operative atrial fibrillation.
abstract: OBJECTIVE
  Our goal was to investigate whether left ventricular (LV) diastolic dysfunction was an important pathophysiological mechanism underlying the initiation of new-onset post-operative atrial fibrillation (POAF).
  
  
  BACKGROUND
  Atrial fibrillation is a common complication after cardiac surgery. However, the precise mechanism underlying its development remains poorly understood. Pre-existing alterations of myocardial diastolic function may predispose patients to the development of POAF.
  
  
  METHODS
  Patients were residents of Olmsted County, Minnesota, who underwent complete LV diastolic function assessment before coronary artery bypass grafting and/or valve surgery between January 1, 2000, and December 31, 2005. All were in sinus rhythm and had no history of atrial fibrillation, a pacemaker, mitral stenosis, or congenital heart disease. POAF was defined as any episode of atrial fibrillation within 30 days after surgery.
  
  
  RESULTS
  POAF occurred in 135 of 351 patients (38.5%). Patients with POAF were older (mean age 72.5 ± 10.3 years vs. 63.1 ± 14.1 years; p < 0.001) and more likely to have abnormal diastolic function. The rate of POAF increased exponentially with diastolic function grade (DFG) severity (p < 0.001). By multivariate analysis, after adjusting for clinical and surgical risk factors, independent predictors of POAF were older age (odds ratio [OR]: 1.05; p < 0.001), higher body mass index (OR: 1.06; p = 0.03), and abnormal LV DFG (DFG 1, OR: 5.12 [p = 0.006]; DFG 2, OR: 9.87 [p < 0.001]; and DFG 3, OR: 28.52 [p < 0.001]).
  
  
  CONCLUSIONS
  LV diastolic dysfunction is a powerful, independent predisposing substrate for the initiation of POAF. Evaluation may be useful during risk stratification of patients undergoing cardiac surgery.
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA. melduni.rowlens@mayo.edu
authors.forename: Rowlens M
authors.initials: RM
authors.lastname: Melduni
authors.forename: Rakesh M
authors.initials: RM
authors.lastname: Suri
authors.forename: James B
authors.initials: JB
authors.lastname: Seward
authors.forename: Kent R
authors.initials: KR
authors.lastname: Bailey
authors.forename: Naser M
authors.initials: NM
authors.lastname: Ammash
authors.forename: Jae K
authors.initials: JK
authors.lastname: Oh
authors.forename: Hartzell V
authors.initials: HV
authors.lastname: Schaff
authors.forename: Bernard J
authors.initials: BJ
authors.lastname: Gersh
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000453:epidemiology* / Q000503:physiopathology*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D015331:Cohort Studies; D003971:Diastole / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance / Q000379:methods; D011183:Postoperative Complications / Q000453:epidemiology* / Q000503:physiopathology*; D012307:Risk Factors; D018487:Ventricular Dysfunction, Left / Q000453:epidemiology* / Q000503:physiopathology*