title: Preoperative left atrial dysfunction and risk of postoperative atrial fibrillation complicating thoracic surgery.
abstract: OBJECTIVE
  Postoperative atrial fibrillation complicating general thoracic surgery increases morbidity and stroke risk. We aimed to determine whether preoperative atrial dysfunction or other echocardiographic markers are associated with postoperative atrial fibrillation.
  
  
  METHODS
  In 191 patients who had undergone anatomic lung or esophageal resection, preoperative clinical and echocardiographic data were compared between patients with and without postoperative atrial fibrillation. Presence of postoperative atrial fibrillation lasting more than 5 minutes during hospitalization was detected using continuous telemetry or 12-lead electrocardiography. Maximal left atrial volume and indices of left atrial function were assessed.
  
  
  RESULTS
  Patients with postoperative atrial fibrillation (33/191, 17%) were older (71 ± 5 years vs 64 ± 12 years, P < .0001), were taking β-blockers more often, had greater left atrial volume, had decreased left atrial emptying fraction, and had lower E' and A' septal velocities compared with patients without postoperative atrial fibrillation. The incidence of postoperative atrial fibrillation in patients with left atrial volume 32 mL/m(2) or greater was 37% (11/30) and greater than in those with left atrial volume less than 32 mL/m(2) (14%, 22/160, P = .002). Length of hospital stay was significantly increased in patients with postoperative atrial fibrillation compared with patients without (P = .04). Older age was significantly associated with greater β-blocker use and left atrial volume and lower left atrial emptying fraction. On multivariate analysis, lower left atrial emptying fraction (odds ratio, 1.03 per unit decrement; 95% confidence interval, 1.002-1.065; P = .04) and preoperative use of β-blockers (odds ratio, 2.82; 95% confidence interval, 1.18-6.77; P = .02) were the only independent risk factors associated with postoperative atrial fibrillation.
  
  
  CONCLUSIONS
  These data show that an echocardiogram before major thoracic surgery, increased use of preoperative β-blockers, and decreased left atrial emptying fraction were associated with postoperative atrial fibrillation. Echocardiographic predictors of left atrial mechanical dysfunction may prove clinically useful in risk stratifying patients in whom postoperative atrial fibrillation is more likely to develop and to benefit from prevention strategies aimed at mitigating atrial function before surgery.
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
authors.forename: Tina
authors.initials: T
authors.lastname: Raman
authors.forename: Nancy
authors.initials: N
authors.lastname: Roistacher
authors.forename: Jennifer
authors.initials: J
authors.lastname: Liu
authors.forename: Hao
authors.initials: H
authors.lastname: Zhang
authors.forename: Weiji
authors.initials: W
authors.lastname: Shi
authors.forename: Howard T
authors.initials: HT
authors.lastname: Thaler
authors.forename: David
authors.initials: D
authors.lastname: Amar
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000009:adverse effects; D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000209:etiology*; D016279:Atrial Function, Left; D016009:Chi-Square Distribution; D004452:Echocardiography; D004562:Electrocardiography; D016629:Esophagectomy / Q000009:adverse effects*; D005260:Female; D006325:Heart Atria / Q000503:physiopathology; D006331:Heart Diseases / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009519:New York City; D016017:Odds Ratio; D018579:Patient Selection; D013510:Pulmonary Surgical Procedures / Q000009:adverse effects*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D000319:Adrenergic beta-Antagonists