Predictors Of Postoperative Atrial Fibrillation Research Articles

The association between low serum calcium level and new-onset atrial fibrillation after coronary artery bypass grafting.

This study aims to investigate the relationship between serum calcium (SC) levels and the incidence of postoperative atrial fibrillation (POAF) in patients undergoing coronary artery bypass graft surgery. This retrospective, observational cohort study consecutively enrolled patients undergoing isolated coronary artery bypass grafting in Beijing Anzhen Hospital from January 2018 to December 2021. Patients with a previous history of atrial fibrillation or atrial flutter or requiring concomitant cardiac surgery were excluded. A logistic regression model was used to determine predictors of POAF. Multivariable adjustment, inverse probability of treatment weighting and propensity score matching were used to adjust for confounders. Moreover, we conducted univariable and multivariable logistic regression analyses on preoperative and postoperative SC and ionized SC levels. The analysis encompassed 12 293 patients. The POAF rate was significantly higher in patients with low SC level than those without (1379 [33.9%] vs 2375 [28.9%], P < 0.001). Low SC level was associated with an increased odds ratio of POAF (odds ratio [95% confidence interval]: 1.27 [1.18-1.37], P < 0.001). Inverse probability of treatment weighting and propensity score matching analyses confirmed the results. The increased POAF rate in low SC level group still existed among subgroup analysis based on different age, sex, body mass index, hypertension, hyperlipidaemia, CHA2DS2-VASc and magnesium. Low SC level indicates elevated POAF risk in patients undergoing isolated coronary artery bypass graft surgery even after the adjustment for age, sex, cardiovascular risk factors, echocardiographic parameters and laboratory markers.

Low-normal free triiodothyronine as a predictor of post-operative atrial fibrillation after surgical coronary revascularization.

Recent studies have focused on the association between thyroid function within normal range and cardiovascular diseases, especially on free triiodothyronine (FT3) levels. This study aims to evaluate the effects of normal FT3 level on new-onset atrial fibrillation (AF) in patients with surgical coronary revascularization. The patients who underwent surgical coronary revascularization were enrolled in the retrospective study. Thyroid function was tested after an overnight fast on the first morning of hospitalization. Serum FT3 level was divided into quartile groups within the normal range. Hazards ratios (HRs) of FT3 level for AF were analyzed by COX proportional hazard model. This study included 503 patients with a mean [standard deviation (SD)] age of 63 (±9) years, and 396 (78.73%) were male. Post-operative AF (POAF) occurred in 120 (23.86%) patients at a median of two days after surgical coronary revascularization. The cumulating incidence of AF was significantly higher in the FT3 quartile 1 (Q1) group especially in older patients as evidenced by Kaplan-Meier analysis. Additionally, the patients who experienced AF had longer hospital stays, the same result was also found in the FT3 Q1 group. Further study demonstrated that low-normal FT3 was an independent predictor of POAF [HR =1.52, 95% confidence interval (CI): 1.01, 2.28, P=0.045]. Low-normal FT3 is associated with an increased risk of POAF and is an independent predictor of POAF. Patients who experienced AF have longer hospital stays. The findings may help to identify patients with surgical coronary revascularization at a higher risk for the development of AF.

Predict postoperative atrial fibrillation after cardiac surgery thanks to a preoperative macrophages functional in vitro test

Predict postoperative atrial fibrillation after cardiac surgery thanks to a preoperative macrophages functional in vitro test

Subacute postoperative atrial fibrillation after heart surgery: Incidence and predictive factors in cardiac rehabilitation

AbstractBackgroundPostoperative atrial fibrillation (POAF) is the most common arrhythmia following cardiac surgery (CS). It may occur between the 1st and the 4th postoperative day as acute POAF or between the 5th and the 30th as subacute (sPOAF). sPOAF is associated with higher thromboembolic risk, which consistently increase patients' morbidity. Neutrophil‐to‐lymphocyte ratio (NLR) is a low‐cost inflammatory index proposed as possible POAF predictor. Identification of patients' risk categories might lead to improved postoperative outcomes.MethodsThe aim was to assess the incidence of sPOAF and to identify possible predictors in patients performing cardiovascular rehabilitation (CR) after CS. A single‐center cohort study was performed on 737 post‐surgical patients admitted to CR on sinus rhythm. Continuous monitoring with 12‐lead ECG telemetry was performed. We evaluated the predictive role of anamnestic, clinical, and laboratory data, including baseline NLR.ResultsSubacute POAF was documented in 170 cases (23.1%). At the multivariate analysis, age (OR 1.03; p = .001), mitral valve surgery (OR 1.77; p = .012), acute POAF (OR 2.97; p &lt; .001), and NLR at baseline (OR 1.13; p = .042) were found to be independent predictive factors of sPOAF following heart surgery.ConclusionssPOAF is common after CS. Age, mitral valve procedures, acute POAF, and preoperative NLR were proved to increase sPOAF occurrence in CR. NLR is an affordable and reliable parameter which might be used to qualify the risk of arrhythmias at CR admission. Identification of new predictors of postoperative atrial fibrillation may allow to improve patients' prognosis.

Abstract 11723: Predictors of Post-Operative Atrial Fibrillation in Patients Undergoing Stress Echocardiography Prior to Noncardiac Surgery

Background: Atrial fibrillation (a-fib) occurs in up to 40% of patients after noncardiac surgery and is associated with increased risk of adverse outcomes. Practice guidelines recommend stress testing, including stress echocardiography (SE) to assess for coronary artery disease in selected high-risk patients prior to noncardiac surgery. The utility of using SE findings for predicting postoperative a-fib is unknown. Hypothesis: Myocardial ischemia can contribute to arrhythmogenic potential; other echocardiographic variables are likely associated with a-fib. Findings on SE may identify patients at risk for a-fib after noncardiac surgery. Aims: To determine if certain SE findings predict a-fib following noncardiac surgery. Methods: The study included patients undergoing pharmacological and exercise SE before noncardiac surgery. The primary outcome was a-fib/flutter within 30 days after surgery. Multivariate analysis was adjusted for age, cardiovascular comorbidities, and markers of surgical risk. Results: This analysis included 2,376 patients (mean age 68 +/- 7 years; 60% male); 1,986 patients had no known history of a-fib/flutter. Of these, 48 (2.4%) developed postoperative a-fib/flutter. In multivariate analysis, SE variables associated with development of new a-fib/flutter included left ventricular dilation (OR 2.11, p=0.049), increased left atrial volume (OR 1.19, p=0.045), and increased left ventricular mass index (OR 1.13, p=0.043) on rest images. The presence of ischemia or infarct on stress echocardiogram was not associated with postoperative a-fib/flutter. A total of 390 patients had a history of paroxysmal a-fib/flutter and were in sinus rhythm at the time of surgery. Of these, 90 (23%) experienced recurrent a-fib/flutter within 30 days of surgery. Multivariate analysis did not reveal any SE variables significantly associated with recurrence, including presence of myocardial ischemia or infarct at the time of SE. Conclusions: All SE variables associated with postoperative a-fib following noncardiac surgery are available from resting images alone. Therefore, SE that includes comprehensive resting images may offer benefit in the pre-operative evaluation of selected patients.

Prospective Study of Risk Factors for Postoperative Atrial Fibrillation After Cardiac Surgery

IntroductionTo examine risk factors for new-onset postoperative atrial fibrillation (POAF) after cardiac surgery. MethodsPatients enrolled in the Cardiothoracic Surgical Trials Network multicenter, randomized trial of rate control versus rhythm control for POAF were included. Predictors of POAF were determined using multivariable logistic regression. ResultsAmong the 2104 patients who were enrolled preoperatively, 695 developed POAF (33.0%). Rates of POAF were 28.1% after isolated coronary artery bypass grafting (CABG), 33.7% after isolated valve repair or replacement, and 47.3% after CABG plus valve repair or replacement. Baseline characteristics associated with an increased risk of POAF identified on multivariable analysis included older age (odds ratio [OR] 1.57; 95% confidence interval [CI] 1.42-1.73, per 10 y), White race or non-Hispanic ethnicity (OR 1.52; CI: 1.11-2.07), history of heart failure (OR 1.55; CI: 1.16-2.08), and history of hypothyroidism (OR 1.42; CI 1.04-1.94). The type of cardiac procedure was associated with an increased risk of POAF with both isolated valve repair or replacement (OR 1.33, CI 1.08-1.64) and combined CABG plus valve repair or replacement (OR 1.64, CI 1.24-2.17) having increased risk of POAF compared to isolated CABG. No preoperative cardiac medication was associated with POAF. ConclusionsIn this prospective cohort of patients, older age, a history of hypothyroidism, a history of heart failure, and valve repair or replacement, with or without CABG, and White non-Hispanic race were associated with an increased risk of POAF.

PO-02-202 CORONARY SINUS PRESSURE FOLLOWING RETROGRADE CARDIOPLEGIA PREDICTS POSTOPERATIVE ATRIAL FIBRILLATION

Coronary sinus cannulation and occlusion are routinely performed during cardiac surgery for administration of retrograde cardioplegia. Under these circumstances, coronary sinus occlusion pressure closely parallels left ventricular end-diastolic pressure, and thus serves as a surrogate for left atrial pressure. Left ventricular diastolic dysfunction has been identified as an important predictor of post-operative atrial fibrillation (POAF). In the setting of impaired left ventricular compliance, left atrial pressure is highly sensitive to very small volume shifts, thereby stretching the left atrium and increasing pulmonary veins arrhythmogenic activity. We hypothesized that elevation of coronary sinus occlusion pressure during cardiac surgery is indicative of increased left atrial pressure and thus may predict the occurrence of POAF. Consecutive patients (n=91, age 65 ± 11yrs) underwent cardiac surgery with retrograde cardioplegia. Patients with a history of atrial fibrillation were excluded. Baseline mean coronary sinus occlusion pressure was obtained following cannulation of the coronary sinus for administration of retrograde cardioplegia before initiation of bypass. The mean coronary sinus occlusion pressure was measured again during bypass as well as immediately after removal of the aortic cross clamp. Clinical outcomes and post-operative complications were collected until hospital discharge. Baseline clinical and procedural characteristics were compared among patients who developed POAF and those who did not. Eleven of the 91 patients (12%) developed POAF. In patients who developed POAF, post-bypass cardiac index was lower (2.4±0.3 vs 2.9±1.1 L/min/m2, p =0.004) and post-bypass coronary sinus occlusion pressure was higher compared to those who did not (16.5±9.5 vs 9.0±6.0 mm Hg, p = 0.036). Post-bypass coronary sinus occlusion pressure was independently predictive of POAF after adjusting for post-bypass cardiac index [OR 1.2 (95% CI 1.1-1.3), p=0.003]. Post-bypass coronary sinus occlusion pressure is significantly higher in patients who develop POAF, reflecting the development of post-bypass impaired relaxation and increased left atrial pressure. Given the ubiquitous use of coronary sinus occlusion during bypass procedures and the ease of measurement of post-bypass coronary sinus occlusion pressure, this may be a valuable and inexpensive tool for POAF risk stratification.

Predict postoperative atrial fibrillation after cardiac surgery thanks to a preoperative macrophages functional in vitro test

Postoperative atrial fibrillation (POAF) is a common complication after cardiac surgery with an incidence of 30%. Cardiac surgery induces a postoperative inflammatory response mediated by innate immunity and associated with POAF. Our aim is to associate the level of in vitro response of preoperative innate immunity with POAF. An in vitro stimulation test by LPS + ATP or R848 was achieved on macrophages derived from preoperative classic monocytes, in patients hospitalized for cardiac surgery, between February and July 2022 (POMI-AF cohort NCT03376165). Then, an assay of pro-inflammatory cytokines (IL-1β, TNFα, IL-6) was carried out by ELISA method after 24 hours of stimulation. In all, 57 patients were included, whose 18 patients who presented POAF (33%). Stimulation test induces a significant increase of IL-1, TNF and IL-6 rates with LPS + ATP or R848. In the “POAF” group, a 2 times higher production of IL-1β, TNFα and IL-6 after LPS + ATP was observed, without reaching statistical significance. After stimulation with R848, we also highlight a 4 times higher production of TNFα and 2 times higher production of IL-6 in the “POAF” group, without reaching statistical significance. Level of in vitro response of preoperative innate immunity appears to be wider after stimulation in patients with POAF after cardiac surgery, but it should be explored on a larger number of patients.

Evaluation of left atrial strain using speckle-tracking echocardiography to predict postoperative atrial fibrillation after coronary artery bypass grafting: a systematic review and meta-analysis

Aim. To conduct a systematic review and meta-analysis to investigate the prognostic role of left atrial (LA) strain assessment using speckle-tracking echocardiography to predict postoperative atrial fibrillation (POAF) in patients undergoing coronary bypass grafting (CABG).Material and methods. We searched the PubMed (Medline) and Google Scholar databases for studies investigating LA strain measures obtained by speckle tracking echocardiography as predictors of POAF in patients after CABG. To determine the difference in the weighted average LA strain parameters, an analysis was made of the global LA strain, peak atrial longitudinal strain (PALS), left atrial conduit strain (LACS) and left atrial contractile strain (LACtS). Odds ratio (OR) values were received from multivariate models reporting association between PALS and POAF and described as pooled estimates with 95% confidence intervals (CI).Results. Twelve studies from 404 publications were selected for this systematic review and meta-analysis. A total of 1093 patients were included in the analysis, with a mean age of 60,5 years. A meta-analysis showed that patients with POAF had lower global LA strain than patients without POAF (difference in weighted values, 5,03%; 95% CI: -6,89 to -3,16; p&lt;0,001). In addition, patients with POAF had lower PALS, LACS and LACtS; the difference in weighted values was 9,90% (95% CI: -12,95 to -6,85; p&lt;0,001), 4,17% (95% CI: -6,05 to -2,29; p&lt;0,001) and 6,1 7% (95% CI: -12,01 to -0,33; p=0,04), respectively. Moreover, in a pooled odds ratio (OR) analysis, PALS was found to be an independent predictor of POAF (OR: 0,88 for every 1% increase in PALS; 95% CI: 0,82–0,94; p&lt;0,0001).Conclusion. Assessment of LA strain using speckle-tracking echocardiography provides important additional information for predicting POAF in patients undergoing isolated CABG.

Left Atrial Function as a Predictor for Postoperative Atrial Fibrillation

Background: One of the most frequent complications following heart surgery is atrial fibrillation (AF). The most popular diagnostic procedure for evaluating atrial function is echocardiography, however it has certain drawbacks. Originally, 2D echocardiography has been used to measure volumes to determine left atrial function. Objective: to examine the relationship between the development of post-operative AF following isolated CABG and preoperative evaluation of LA function using 2D echocardiography and left atrium 2D speckle tracking strain echocardiography. Patients and Methods: A set of 149 consecutive patients enrolled in a prospective observational study, they admitted to cardio-thoracic surgery department for elective isolated coronary artery bypass grafting surgery, during July 2018 to June 2019. 22 patients were excluded from the study due to bad image quality. Results: Readings of speckle tracking data showed significant less LA reservoir strain (OR 1.75, 95% CI: 0.65-4.69, P≤0001), LA conduit strains (OR 0.6, 95% CI: 0.22-1.62, P=0.31) and LA contractile strain (OR 0.65, 95% CI: 0.24-1.77, P=0.40) in POAF (+). Remaining parameters were non-significant. Also, Age (P=0.03), LA diameter (P=0.04), and LAVI (P=0.03) were the only factors that were identified as potential predictors of POAF in multivariate logistic regression analysis. Conclusion: we concluded that, age, LA size and LAVI are significantly associated with the occurrence of POAF in our patients.

A prediction model for new-onset atrial fibrillation following coronary artery bypass graft surgery: A multicenter retrospective study

ObjectiveDeveloping and assessing a risk prediction model of postoperative atrial fibrillation (POAF) after coronary artery bypass grafting (CABG), and aims to provide a reference for the prediction and prevention. DesignA retrospective case-control study. SettingThree major urban teaching and university hospitals and tertiary referral centers. Participantsconsecutive patients undergoing CABG. InterventionsThe study was retrospective and no interventions were administered to patients. Measurements and main resultsIn the study, the overall new-onset POAF prevalence was approximately 28%. A prediction model for POAF with nine significant indicators was developed, and identified new predictors of POAF: left ventricular end diastolic diameter (LVEDD), intraoperative defibrillation, and intraoperative temporary pacing lead implantation. The model had good discrimination in both the derivation and validation cohorts, with the area under the receiver operating characteristic curves (AUCs) of 0.621 (95% CI = 0.602–0.640) and 0.616 (95% CI = 0.579–0.651), respectively, and showed good calibration. Compared with CHA2DS2-VASc, HATCH score, and the prediction model of POAF after CABG developed based on a small sample of clinical data from a single center in China, the model in this study had better discrimination. ConclusionWe have developed and validated a new prediction model of POAF after CABG using multicenter data that can be used in the clinic for early identification of high-risk patients of POAF, and to help effectively prevent POAF in postoperative patients.

Myeloperoxidase in the pericardial fluid improves the performance of prediction rules for postoperative atrial fibrillation.

After surgery, inflammation is a prominent factor influencing postoperative atrial fibrillation. Myeloperoxidase is a major contributor to inflammatory responses after surgical tissue damage. We evaluated whether myeloperoxidase is associated with postoperative atrial fibrillation clinically and in an animal model. This prospective cohort study included patients undergoing isolated coronary artery bypass grafting. Myeloperoxidase concentrations in blood and pericardial fluid were determined at baseline and 6, 12, and 18hours after coronary artery bypass grafting. Myeloperoxidase activity in blood, pericardial fluid, and atrium were also evaluated in a canine coronary artery bypass grafting model. Electrophysiologic, histologic, and immunohistochemistry analyses were performed to explore underlying mechanisms. Postoperative atrial fibrillation occurred in 45 of 137 patients (32.8%). Patients with postoperative atrial fibrillation had significantly higher serum and pericardial myeloperoxidase levels. Individual clinical and surgical factors had moderate predictive value (area under the curve, 0.760) for postoperative atrial fibrillation. Discrimination improved remarkably when myeloperoxidase was combined with other parameters (area under the curve, 0.901). Pericardial myeloperoxidase at 6hours postoperatively was the strongest independent predictor of postoperative atrial fibrillation (odds ratio, 19.215). The rate of postoperative atrial fibrillation increased exponentially across pericardial myeloperoxidase grades. Compared with controls, coronary artery bypass grafting-treated dogs showed higher atrial fibrillation vulnerability and maintenance, shorter atrial effective refractory period, attenuated connexin 43 expression, and increased myocardial and pericardial myeloperoxidase activity. Connexin 43 expression and atrial effective refractory period were strongly negatively correlated with myocardial and pericardial myeloperoxidase activity. Myeloperoxidase is linked to postoperative atrial fibrillation, and the ability to predict postoperative atrial fibrillation was remarkably improved by adding pericardial myeloperoxidase. Myeloperoxidase-related atrial structural and electrical remodeling is a physiologic substrate for this arrhythmia.

Blood group as a novel predictor of postoperative atrial fibrillation after off-pump coronary artery bypass grafting.

The objective of this study was to reveal whether there was a possible relationship between the blood group and postoperative atrial fibrillation after off-pump coronary artery bypass grafting. Between January 2020 and January 2022, 452 patients undergoing off-pump coronary artery bypass grafting surgery consisted of the research population. Patients were divided into two groups based on the occurrence of new-onset atrial fibrillation from the time of operation until discharge. Group 1 (atrial fibrillation group) had 122 patients, whereas group 2 (non-atrial fibrillation group) contained 350 patients. Patients' baseline clinical characteristics and operative and postoperative data were recorded and then compared between the groups. Moreover, a multivariate logistic regression analysis was also conducted to identify the predictors of postoperative atrial fibrillation. Non-O blood groups were substantially more common in the atrial fibrillation group than in the non-atrial fibrillation group. Patient age differences between the atrial fibrillation and non-atrial fibrillation groups were statistically significant, and patients in the atrial fibrillation group were detected to be older. Mean left atrial diameter, rates of obesity and prior percutaneous coronary intervention history, and perioperative intraaortic balloon pump requirement were significantly greater in the atrial fibrillation group than in the non-atrial fibrillation group. According to logistic regression analysis, blood group, age, left atrial diameter, obesity, and prior percutaneous coronary intervention were identified as predictors of postoperative atrial fibrillation. We demonstrated for the first time in the literature that ABO blood type was a novel and significant predictor of new-onset atrial fibrillation after off-pump coronary artery bypass grafting.

Incidence and Predictors of Postoperative Atrial Fibrillation after Coronary Artery Bypass Grafting Surgery

Objective: To study the incidence of postoperative atrial fibrillation (POAF) and its predictors after coronary artery bypass grafting (CABG) in an Asian cohort.&#x0D; Study Design: Cross sectional study.&#x0D; Place and Duration of Study: The study was conducted at the department of Cardiothoracic Surgery, Almana Hospital, Al Khobar, Saudi Arabia, which is a tertiary care hospital. The study duration was form Oct 2019 to Dec 2021. &#x0D; Methodology: All the male and female consecutive patients with coronary artery disease undergoing coronary artery bypass grafting (CABG) were included in the study. All the surgeries were performed through median sternotomy using cardiopulmonary bypass. Patients with emergency CABG, off pump CABG and those undergoing multiple procedures were excluded from the study. A total of 220 consecutive patients were included in the study. Patients were followed in the perioperative period. Various variables were recorded on a preformed proforma. Patients were divided into two groups, those who had atrial fibrillation (AF) and those who did not have AF. Data was analyzed using SPPS version 23 (SPSS, Inc., Chicago,IL).&#x0D; Results: The mean age of the patients was 51.50±11 years in the AF group and 49.38±9 years in the no AF group. The incidence of atrial fibrillation postoperatively in our cohort was (n=52, 25%). There was no statistically significant difference between the groups with respect to hypertension and diabetes (p=0.408 and p=0.054) respectively).&#x0D; Conclusion: In spite of a younger population, the incidence of AF in our cohort undergoing CABG is comparable to the international literature. Lack of preoperative β-blockers, statins and low ejection fraction are predictors of new onset POAF.

Abstract 13436: Sex-Specific Predictors of Postoperative Atrial Fibrillation and the Role of Cardiometabolic Diseases

Introduction: Cardiometabolic diseases increase the risk of postoperative atrial fibrillation (POAF), which in turn is associated with higher long-term risk of major cardiovascular events (MACE). Little is known regarding the sex-specific impact of cardiometabolic diseases on POAF risk. We evaluated the sex-specific predictors of POAF after coronary artery bypass grafting (CABG), with a focus on preoperative cardiometabolic profile. Methods: In a prospective registry of patients undergoing isolated CABG (2006-2019), we compared predictors of POAF between sexes. We excluded patients with previous AF history, redo/urgent/off-pump CABG, perioperative mortality, and permanent pacemakers/defibrillators. Abdominal obesity was defined as a waist circumference (WC) &gt;102 cm (men [M]) or &gt;88 cm (women [W]). Results: We included 7,851 patients (19% women). Baseline characteristics are presented in Table 1. POAF occurred in 27% of women and 31% of men (p&lt;0.01). Women were older and had a higher prevalence of comorbidities, abdominal obesity and a worse lipid profile. In a logistic regression model adjusting for the variables in Table 1, men had a higher risk of POAF (OR M = 1.4 [1.2-1.6], p&lt;0.01). When stratifying by sex, significant predictors (p&lt;0.05) of POAF for both sexes were age, WC (OR M = 1.04 [1.00-1.08]; OR W = 1.01 [1.00-1.03]), and triglycerides (TG) (OR M = 0.98 [0.97-0.99]; OR W = 0.97 [0.95-0.99]). Sex-specific predictors were creatinine for women and beta-blockers, extracorporeal circulation time, intensive care stay and hemoglobin for men. Conclusions: Women had less POAF but worse preoperative cardiometabolic profile compared to men. WC was a strong predictor of POAF for both sexes, while higher TG levels were protective. Since POAF is linked to future risk of MACE, the preoperative clinical assessment of WC should be encouraged and targeted for preventive strategies, especially in women. More studies are needed to investigate the role of TG in POAF.

Galectin-3 is an independent predictor of postoperative atrial fibrillation and survival after elective cardiac surgery.

Postoperative atrial fibrillation (POAF) is a frequent complication after heart surgery and is associated with thromboembolic events, prolonged hospital stay, and adverse outcomes. Inflammation and fibrosis are involved in the pathogenesis of atrial fibrillation. The purpose of this study was to assess whether galectin-3, which reflects preexisting atrial fibrosis, has the potential to predict POAF and mortality after cardiac surgery. Four hundred seventy-five consecutive patients (mean age 67.4 ± 11.8 years; 336 (70.7%) male) undergoing elective heart surgery at the Medical University of Vienna were included in this prospective single-center cohort study. Galectin-3 plasma levels were assessed on the day before surgery. The 200 patients (42.1%) who developed POAF had significantly higher galectin-3 levels (9.60 ± 6.83 ng/mL vs 7.10 ± 3.54 ng/mL; P < .001). Galectin-3 significantly predicted POAF in multivariable logistic regression analysis (adjusted odds ratio per 1-SD increase 1.44; 95% confidence interval 1.15-1.81; P = .002). During a median follow-up of 4.3 years (interquartile range 3.4-5.4 years), 72 patients (15.2%) died. Galectin-3 predicted all-cause mortality in multivariable Cox regression analysis (adjusted hazard ratio per 1-SD increase 1.56; 95% confidence interval 1.16-2.09; P = .003). Patients with the highest-risk galectin-3 levels according to classification and regression tree analysis (>11.70 ng/mL) had a 3.3-fold higher risk of developing POAF and a 4.4-fold higher risk of dying than did patients with the lowest-risk levels (≤5.82 ng/mL). The profibrotic biomarker galectin-3 is an independent predictor of POAF and mortality after cardiac surgery. This finding highlights the role of the underlying arrhythmogenic substrate in the genesis of POAF. Galectin-3 may help to identify patients at risk of POAF and adverse outcome after cardiac surgery.

Does the Geriatric Nutritional Risk Index Play a Predictive Role in Postoperative Atrial Fibrillation and Outcomes in Cardiac Surgery?

<h3>Objectives</h3> Malnutrition is associated with adverse surgical outcomes. The Geriatric Nutritional Risk Index, a nutritional screening tool, could be a predictor of postoperative atrial fibrillation and outcomes in cardiac surgery. <h3>Design</h3> The authors enrolled 292 patients who underwent cardiac surgery and showed postoperative atrial fibrillation during hospitalization, and assessed mortality and readmission during a 90-day follow-up period. <h3>Setting</h3> A large academic hospital in China. <h3>Participants</h3> Participants were divided into low-risk (Geriatric Nutritional Risk Index <98) and no-risk malnutrition groups (Geriatric Nutritional Risk Index ≥98). <h3>Interventions</h3> Univariate and multivariate logistic regression analyses were used to validate the role of the Geriatric Nutritional Risk Index in predicting postoperative atrial fibrillation. Kaplan–Meier analysis was used to examine the effect of Geriatric Nutritional Risk Index scores on mortality and readmission after cardiac surgery. <h3>Measurements and Main Results</h3> A total of 136 patients were in the low-risk malnutrition group. Postoperative atrial fibrillation was more common in the low-risk group (63.2% <i>v</i> 28.8%, p < 0.001). Duration of intensive care unit stays and hospitalization were significantly longer than in the no-risk group (44 [43] <i>v</i> 39 [47] hours, p < 0.001; 18 [7] <i>v</i> 15 [6] days, p < 0.001). Multivariate analysis showed that Geriatric Nutritional Risk Index, age, and NYHA class independently predicted postoperative atrial fibrillation. Kaplan–Meier analysis showed that 90-day all-cause readmission, but not 90-day all-cause mortality, was different between groups based on the Geriatric Nutritional Risk Index (log-rank p < 0.001, log-rank p = 0.09). <h3>Conclusions</h3> The easily accessible Geriatric Nutritional Risk Index used for nutritional assessment before cardiac surgery has a predictive role in postoperative atrial fibrillation, and is related to short-term readmission.

Prediction of postoperative atrial fibrillation with the systemic immune-inflammation index in patients undergoing cardiac surgery using cardiopulmonary bypass: a retrospective, single-center study.

The systemic immune-inflammation index (SII, platelet count × neutrophil-lymphocyte ratio) is a novel parameter for systemic inflammation. Cardiopulmonary bypass (CPB) is associated with systemic inflammatory responses. This retrospective study aimed to determine whether SII could predict postoperative atrial fibrillation (POAF) after cardiac surgery using CPB. Patients who underwent cardiac surgery using CPB between January 2020 and July 2021 were included. The primary outcome was POAF incidence within 7days. Receiver-operating characteristic (ROC) curve analysis was used to evaluate SII ability in predicting POAF. Multivariable analysis was used to estimate the independent association between SII and POAF development. The study included 212 patients, and 90 (43%) developed POAF. The preoperative SII cutoff of 545 × 109/L predicted a poor outcome with 71% sensitivity and 81% specificity. The area under the ROC curve was 0.80 (95% confidence interval [CI] 0.73-0.86). Multivariable analysis showed that SII ≥ 545 × 109/L was associated with the development of POAF (odds ratio 10.2; 95% CI 5.1-20.2, P < 0.001). SII predicted POAF with a curve of 0.91 (95% CI 0.82-1.00) in patients with coronary artery bypass grafting (CABG); the corresponding value in patients without CABG was 0.75 (95% CI 0.67-0.83). Preoperative SII may be a useful prognostic biomarker for POAF in patients undergoing cardiac surgery using CPB. Moreover, preoperative SII may play an important role in predicting POAF in patients undergoing CABG.

A Genotype-Phenotype Analysis of Glutathione Peroxidase 4 in Human Atrial Myocardium and Its Association with Postoperative Atrial Fibrillation.

Heterogeneity in the incidence of postoperative atrial fibrillation (POAF) following heart surgery implies that underlying genetic and/or physiological factors impart a higher risk of this complication to certain patients. Glutathione peroxidase-4 (GPx4) is a vital selenoenzyme responsible for neutralizing lipid peroxides, mediators of oxidative stress known to contribute to postoperative arrhythmogenesis. Here, we sought to determine whether GPX4 single nucleotide variants are associated with POAF, and whether any of these variants are linked with altered GPX4 enzyme content or activity in myocardial tissue. Sequencing analysis was performed across the GPX4 coding region within chromosome 19 from a cohort of patients (N = 189) undergoing elective coronary artery bypass graft (−/+ valve) surgery. GPx4 enzyme content and activity were also analyzed in matching samples of atrial myocardium from these patients. Incidence of POAF was 25% in this cohort. Five GPX4 variants were associated with POAF risk (permutated p ≤ 0.05), and eight variants associated with altered myocardial GPx4 content and activity (p < 0.05). One of these variants (rs713041) is a well-known modifier of cardiovascular disease risk. Collectively, these findings suggest GPX4 variants are potential risk modifiers and/or predictors of POAF. Moreover, they illustrate a genotype–phenotype link with this selenoenzyme, which will inform future mechanistic studies.

Postoperative Atrial Fibrillation in Lung Transplant Recipients with and without Concomitant Modified Maze

<h3>Purpose</h3> Atrial fibrillation is common following lung transplantation and may contribute to increased risk of stroke. The goal of this study was to characterize the incidence of atrial fibrillation in lung transplant recipients with and without a concomitant modified Maze procedure. <h3>Methods</h3> We conducted retrospective review of adult lung transplant recipients at University of California Los Angeles from June 2008 to August 2021 and identified those who received a concomitant modified Maze procedure, which were performed for intraoperative or history of atrial fibrillation or flutter when technically feasible. Baseline characteristics and incidence of post-operative atrial fibrillation were compared between Maze and non-Maze recipients. Multivariable logistic regression was used to evaluate predictors of postoperative atrial fibrillation. <h3>Results</h3> Of 757 lung transplant recipients identified in our cohort, 61(8%) had concomitant modified Maze. Recipients in the Maze group were older [63(57-67) vs 61(52-66), p=0.02), more likely diagnosis groups A (23% vs 15%) and B (11% vs 4%, p<0.01), had higher CVP [8(4-11) vs 5(3-8) mmHg, p<0.01], pulmonary capillary wedge pressure (13±6 vs 11±6 mmHg, p=0.03), and were more likely to have a left atrial appendage ligation (87% vs 2%, p<0.01). Post-operative atrial fibrillation was significantly higher in the Maze group (44% vs 25%, p<0.01), but no patients in the Maze group developed a stroke at the index lung transplant hospitalization. On multivariable analysis, predictors of post-operative atrial fibrillation included Maze (aOR 2.51, 95% CI 1.40-4.50), male recipient (aOR 1.71, 95% CI 1.18-2.46), hypertension (aOR 1.54, 95% CI 1.09-2.18), BMI (aOR 1.07 per kg/m2, 95% CI 1.07), and white (aOR 5.30, 95% CI 1.53-18.36) and Hispanic race (aOR 3.75, 95% CI 1.05-13.44). <h3>Conclusion</h3> Lung transplant recipients with atrial fibrillation and receiving concomitant Maze still have a significantly higher rate of postoperative atrial fibrillation compared to those who do not require Maze. These patients should have their left atrial appendage ligated when technically feasible to reduce the future risk of stroke.