title: Diastolic dysfunction, cardiopulmonary bypass, and atrial fibrillation after coronary artery bypass graft surgery.
abstract: BACKGROUND
  Atrial fibrillation (AF) is a common complication after coronary artery bypass graft (CABG) surgery, and is associated with increased morbidity, mortality, and utilization of healthcare resources. Diastolic dysfunction (DD) causes a range of changes in left atrial structure and function that may predispose patients to increased risk of AF. We hypothesized that patients with either new or worsened grade of DD after cardiopulmonary bypass (CPB) would have higher prevalence of AF after CABG surgery. The current study sought to determine an association between the dynamic changes in diastolic function during the perioperative period and postoperative AF in patients undergoing CABG surgery.
  
  
  METHODS
  A total of 109 patients undergoing elective CABG surgery were assessed for the presence of DD before and after CPB. All patients were monitored for the development of AF after surgery for the entire hospital stay.
  
  
  RESULTS
  DD was present in 89 (81%) and 91 (83%) patients before and after CPB. Thirty-four (31%) patients had either new or worsened grade of DD after CPB. Postoperative AF was present in 30 (27.5%) patients, including 15 (44%) patients with either new or worsened DD, and 15 (20%) patients with either unchanged or improved DD (P=0.009). Independent predictors of postoperative AF included age ≥65 yr [odds ratio (OR) 4.207, 95% confidence interval (CI) 1.527, 11.588], and new or worsened DD (OR 4.145, 95% CI 1.519, 11.356).
  
  
  CONCLUSIONS
  New or worsened DD after CABG surgery is associated with an increased incidence of postoperative AF.
  
  
  BACKGROUND
  http://www.clinicaltrials.gov; unique identifier NCT00188903.
authors.affiliation: Department of Anesthesia and Pain Management, EN 3-410, Toronto General Hospital, University Health Network, University of Toronto, 200 Elizabeth Street, Toronto, ON, Canada M5G 2C4 Present address: Department of Anaesthesia, c/o St Vincent's Hospital,390 Victoria Street, Darlinghurst, NSW 2010, Australia.
authors.forename: C M
authors.initials: CM
authors.lastname: Ashes
authors.affiliation: Department of Anesthesia and Pain Management, EN 3-410, Toronto General Hospital, University Health Network, University of Toronto, 200 Elizabeth Street, Toronto, ON, Canada M5G 2C4.
authors.forename: M
authors.initials: M
authors.lastname: Yu
authors.affiliation: Department of Anesthesia and Pain Management, EN 3-410, Toronto General Hospital, University Health Network, University of Toronto, 200 Elizabeth Street, Toronto, ON, Canada M5G 2C4.
authors.forename: M
authors.initials: M
authors.lastname: Meineri
authors.affiliation: Department of Anesthesia and Pain Management, EN 3-410, Toronto General Hospital, University Health Network, University of Toronto, 200 Elizabeth Street, Toronto, ON, Canada M5G 2C4.
authors.forename: R
authors.initials: R
authors.lastname: Katznelson
authors.affiliation: Department of Anesthesia and Pain Management, EN 3-410, Toronto General Hospital, University Health Network, University of Toronto, 200 Elizabeth Street, Toronto, ON, Canada M5G 2C4.
authors.forename: J
authors.initials: J
authors.lastname: Carroll
authors.affiliation: Division of Cardiovascular Surgery, University Health Network, University of Toronto, Toronto, ON, Canada M5G2C4.
authors.forename: V
authors.initials: V
authors.lastname: Rao
authors.affiliation: Department of Anesthesia and Pain Management, EN 3-410, Toronto General Hospital, University Health Network, University of Toronto, 200 Elizabeth Street, Toronto, ON, Canada M5G 2C4 george.djaiani@uhn.ca.
authors.forename: G
authors.initials: G
authors.lastname: Djaiani
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000758:Anesthesia; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging / Q000209:etiology*; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D005260:Female; D054144:Heart Failure, Diastolic / Q000000981:diagnostic imaging / Q000209:etiology*; D006334:Heart Function Tests; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000209:etiology*; D014463:Ultrasonography
keywords: atrial fibrillation; coronary artery bypass; echocardiography, transoesophageal; heart failure, diastolic