Abstract
BackgroundBody mass index (BMI), age, left atrium (LA) dimension and left ventricular ejection fraction (LVEF) have been linked to post-operative atrial fibrillation (POAF) after cardiac surgery. The aim of this study was to better define the role of these risk factors.MethodsThis retrospective cohort study evaluated 249 patients (without prior atrial dysrhythmia) undergoing cardiac or aortic surgery. Prior to surgery, the following data were collected: age, BMI, LA diameter, LA area, LVEF, thyroid stimulating hormone (TSH), creatinine and the presence of arterial hypertension (AH) and diabetes. Intraoperative data such as operation time, total clamp time, cardiopulmonary bypass time, and presence of pericardial/pleural effusion were also collected. Only patients without pre- and post-surgery prophylactic anti-arrhythmic therapy were included.ResultsPatients with (N = 127, 51%) and without POAF (N = 122, 49%) were compared. No difference was observed for sex, LA diameter, LA area, LVEF, TSH, diabetes and use of ACE inhibitors or statins prior to intervention. Moreover, no difference was observed in terms of operation time, total clamp time, cardiopulmonary bypass time, and presence of pericardial/pleural effusion. However, patients with POAF were older (70.6 ± 10.7 vs. 60.4 ± 16.4 years, p = 0.001), had higher BMI (26.8 ± 4.5 vs. 24.9 ± 3.6 kg/m2, p = 0.001), higher baseline creatinine (1.06 ± 0.91 vs. 0.88 ± 0.32 mg/dL, p = 0.038) and a higher frequency of arterial hypertension (73.2% vs. 50%, p = 0.001) and Bentall procedure (24.4% vs. 9.8%, p = 0.023). Multivariate analysis showed that the only independent predictors of POAF were age (OR = 1.05, 95%CI 1.02–1.07, p = 0.001) and BMI (OR = 1.11 95%CI 1.03–1.2,p = 0.006).ConclusionsThese findings suggest that advanced age and a higher BMI are strong risk factors for POAF in patients without previous AF even in the presence of comparable LA dimensions and LVEF.
Highlights
Because of persistent high incidence, increased complications, length of hospitalization and costs, postoperative atrial fibrillation (POAF) is still considered a major problem in cardiac surgery [1,2,3,4]
Body mass index (BMI) is still considered the most practical parameter taken to represent the role played by overweight [7], while other recognized risk factors for post-operative atrial fibrillation (POAF) include advanced age [8, 9], left atrial (LA) dimension [10, 11] and left ventricular systolic dysfunction [12, 13]
The incidence of POAF was observed to increase with advancing age and increasing BMI (Fig. 1)
Summary
Because of persistent high incidence, increased complications, length of hospitalization and costs, postoperative atrial fibrillation (POAF) is still considered a major problem in cardiac surgery [1,2,3,4]. Almost all studies reporting this association have used the body mass index (BMI) to evaluate weight excess [6]. BMI is still considered the most practical parameter taken to represent the role played by overweight [7], while other recognized risk factors for POAF include advanced age [8, 9], left atrial (LA) dimension [10, 11] and left ventricular systolic dysfunction [12, 13]. The aim of the present study was to better define the relative role played by these risk factors comparing patients with and without POAF. Body mass index (BMI), age, left atrium (LA) dimension and left ventricular ejection fraction (LVEF) have been linked to post-operative atrial fibrillation (POAF) after cardiac surgery. The aim of this study was to better define the role of these risk factors
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