Sarin Kunal, Chauhan Sandeep, Bisoi Akshay K, Kapoor Poonam Malhotra, Gharde Parag, Choudhury Arindam
Department of Cardiac Anaesthesiology, All India Institute of Medical Sciences, New Delhi, India.
Department of CTVS, All India Institute of Medical Sciences, New Delhi, India.
Ann Card Anaesth. 2017 Oct-Dec;20(4):403-407. doi: 10.4103/aca.ACA_73_17.
Literature search reveals that postoperative atrial fibrillation (POAF) occurs in 15%-40% of coronary artery bypass graft (CABG) patients. Although several risk models exist for predicting the development of POAF, few have studied left atrial appendage (LAA) velocity. We hypothesize that an association between LAA velocity and development of POAF exists.
Single institution university hospital prospective observational clinical study performed between May 2016 and November 2016 in 96 adult patients undergoing CABG surgery utilizing cardiopulmonary bypass (CPB). Transesophageal echocardiography was performed perioperatively to measure LAA velocity and left atrial (LA) size after anesthetic induction, post-CPB and during the postoperative period before extubation. Student's t-test was used for inter-group comparisons. Data are expressed as mean ± (standard deviation). The value of P < 0.05 was considered statistically significant.
A total of 95 patients (69 males and 26 females) completed the study and were included in the final analysis. Of these, 21 (22%) (15 males and 5 females) developed POAF. The patient group which developed POAF was compared with the group that did not develop POAF. On comparing mean age of patients in each group (59 years in patients with no POAF and 63.71 years in patients with POAF, P = 0.04). LA volume indexed in POAF group (34.13 ml/m2) compared with that in group with no POAF (34.82 ml/m2) resulted in P = 0.04. Mean LAA velocities (pre-CPB, post-CPB, postoperative Intensive Care Unit) in group with no POAF were 41.06, 56.33, and 60.44 cm/s, respectively, whereas in the other group with POAF the values were 39.68, 55.04, and 58.09 cm/s, respectively. No statistical significance was noted (P > 0.05). Comparison of comorbidities also did not yield any significant results (P > 0.05).
Decreasing LAA velocity does not appear to independently predict the development of POAF in patients undergoing CABG surgery with the use of CPB. There is, however, a positive correlation of POAF with age and LA volume.
文献检索显示，冠状动脉旁路移植术（CABG）患者中15%-40%会发生术后房颤（POAF）。尽管存在多种预测POAF发生的风险模型，但很少有研究关注左心耳（LAA）速度。我们假设LAA速度与POAF的发生之间存在关联。
2016年5月至2016年11月在一家单机构大学医院对96例接受体外循环（CPB）下CABG手术的成年患者进行了前瞻性观察性临床研究。围手术期行经食管超声心动图检查，测量麻醉诱导后、CPB后以及拔管前术后期间的LAA速度和左心房（LA）大小。采用学生t检验进行组间比较。数据以平均值±（标准差）表示。P<0.05的值被认为具有统计学意义。
共有95例患者（69例男性和26例女性）完成研究并纳入最终分析。其中，21例（22%）（15例男性和5例女性）发生POAF。将发生POAF的患者组与未发生POAF的患者组进行比较。比较每组患者的平均年龄（未发生POAF的患者为59岁，发生POAF的患者为63.71岁，P=0.04）。POAF组的左房容积指数（34.13 ml/m²）与未发生POAF组（34.82 ml/m²）相比，P=0.04。未发生POAF组的平均LAA速度（CPB前、CPB后、术后重症监护病房）分别为41.06、56.33和60.44 cm/s，而另一组发生POAF的患者相应值分别为39.68、55.04和58.09 cm/s。未发现统计学意义（P>0.05）。合并症的比较也未得出任何显著结果（P>0.05）。
在接受CPB下CABG手术的患者中，LAA速度降低似乎不能独立预测POAF的发生。然而，POAF与年龄和左房容积呈正相关。
