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Predicting Post-operative Atrial Fibrillation in Cardiac Surgery – The Added Value of Echocardiography

Marija Gjerakaroska-Radovikj, Vasil Papestiev, Sashko Jovev

Abstract:INTRODUCTION: Post-operative atrial fibrillation (POAF) is a frequent rhythmic complication in cardiac surgery with the potential to cause sudden hemodynamic instability and catastrophic thromboembolic complications. Despite vast scientific research, it is still hard to predict and prevents its occurrence. AIM: The aim of this study was to determine whether selected pre-operative and intraoperative echocardiographic variables would be of added value in POAF prediction. МАTERIAL AND METHODS: This prospective observational follow-up study included 178 cardiac surgery patients undergoing coronary artery bypass graft intervention. Demographic as well as echocardiographic variables of interest were examined to detect significant independent predictors for POAF. RESULTS: POAF was detected in 90 (50.56%) patients versus 88 (49.44%) patients without POAF. Patients who developed POAF were significantly older and burdened with multiple comorbidities. In multiple regression analysis pre-operative echocardiographic variables-diastolic dysfunctions, enlarged left atrial (LA) volume indexed for body surface area, mitral annular calcification, and secondary mitral regurgitation were predictive of POAF. LA appendage flow velocity obtained by intraoperative transesophageal echocardiography was also a significant intraoperative predictor for POAF. CONCLUSION: The results of this study confirmed that two-dimensional echocardiography is a valuable diagnostic and prognostic tool in relation to POAF. The addition of the aforementioned echocardiographic independent predictors to traditional demographic variables could be a solid foundation of a new predictive model for POAF.

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