Department of Cardiothoracic Surgery, Heart & Vascular Centre, Maastricht University Medical Centre, Maastricht, the Netherlands; Department of Physiology, Maastricht University, Maastricht, the Netherlands.
Department of Cardiothoracic Surgery, Heart & Vascular Centre, Maastricht University Medical Centre, Maastricht, the Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands.
JACC Clin Electrophysiol. 2024 May;10(5):941-955. doi: 10.1016/j.jacep.2024.01.013. Epub 2024 Mar 13.
Postoperative atrial fibrillation (POAF) is a frequent complication after cardiac surgery that is associated with late atrial fibrillation (AF) recurrences (late-POAF) and increased morbidity and long-term mortality.
This study sought to determine device-detected POAF incidence and to identify clinical variables associated with POAF, both in patients with and without preoperative AF history.
A total of 133 consecutive patients undergoing cardiac surgery were prospectively enrolled and continuously monitored with an implantable loop recorder for 2.5 years after surgery. Preoperative transthoracic echocardiography, 12-lead electrocardiogram, blood biomarkers, and clinical data were analyzed to develop prediction models for early- and late-POAF.
In patients without preoperative AF history, early-POAF within the first 90 postoperative days occurred in 41 (47.1%) of 87 patients. Late-POAF after the first 90 postoperative days occurred in 22 (25%) of 87 patients, and 20 of these patients also had early-POAF during the first 90 days (20 of 22 [91%]). Increased right atrial minimum volume indexed for body surface area (RAVI) and early-POAF were independently associated with late-POAF. A prediction model for late-POAF, which included RAVI >11 mL/m, age >65 years, and early-POAF, achieved an area under the curve of 0.82 (95% CI: 0.72-0.92). For patients with preoperative AF-history, late-POAF recurrences were frequent (22 of 33 [67%]). Increased RAVI was independently associated with a higher incidence of late-POAF.
In patients with and without AF history, late-POAF recurrences are frequent, including in patients undergoing surgical AF ablation. In patients with no history of AF, late-POAF might be predicted with excellent accuracy by using a combination of preoperative variables. In patients with a history of AF, signs of advanced AF substrate (eg, increased right atrial volumes) were associated with long-term AF recurrences. [Reappraisal of Atrial Fibrillation: Interaction Between Hypercoagulability, Electrical Remodeling, and Vascular Destabilisation in the Progression of AF; NCT03124576].
术后心房颤动（POAF）是心脏手术后常见的并发症，与晚期心房颤动（AF）复发（迟发性 POAF）以及发病率和长期死亡率增加有关。
本研究旨在确定器械检测到的 POAF 发生率，并确定与 POAF 相关的临床变量，包括有和无术前 AF 病史的患者。
连续前瞻性招募了 133 例接受心脏手术的患者，并在术后 2.5 年内使用植入式环路记录器进行连续监测。分析术前经胸超声心动图、12 导联心电图、血液生物标志物和临床数据，以建立早期和晚期 POAF 的预测模型。
在无术前 AF 病史的患者中，87 例患者中有 41 例（47.1%）在术后 90 天内发生早期 POAF。87 例患者中有 22 例（25%）在术后 90 天后发生晚期 POAF，其中 20 例患者在术后 90 天内也发生了早期 POAF（20/22 [91%]）。右心房最小容积指数（RAVI）增加和早期 POAF 与晚期 POAF 独立相关。一个包含 RAVI＞11ml/m、年龄＞65 岁和早期 POAF 的晚期 POAF 预测模型，其曲线下面积为 0.82（95%CI：0.72-0.92）。对于有术前 AF 病史的患者，晚期 POAF 复发很常见（33 例中有 22 例[67%]）。RAVI 增加与晚期 POAF 发生率较高独立相关。
在有和无 AF 病史的患者中，晚期 POAF 复发很常见，包括接受手术治疗 AF 的患者。在无 AF 病史的患者中，通过术前变量的组合可以很好地预测晚期 POAF。在有 AF 病史的患者中，晚期 AF 底物的迹象（如右心房容积增加）与长期 AF 复发相关。
