Preoperative Tissue Doppler Imaging-Derived Atrial Conduction Time Can Predict Postoperative Atrial Fibrillation in Patients Undergoing Aortic Valve Replacement for Aortic Valve Stenosis

Abstract

Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp and postoperative complications and requirements, have been evaluated as predictors of POAF; however, most of these predictors were not consistent among studies and only advanced age was a consistent predictor. 6 Recently, echocardiographic assessments have achieved much better prediction of POAF by measuring the left atrium-related values including the left atrial volume index (LAVI), LA strain and total atrial conduction time (TACT). Although there are several measurements of TACT, the time interval from the P-wave onset on the electrocardiogram (ECG) to the peak of the A' lateral wave on TDI (PA-TDI duration) provides a reliable estimation of TACT, and the PA-TDI duration has been shown to be significantly related to new-onset AF. 7,8 Our previous study revealed that the PA-TDI duration was predictive of AF in patients undergoing off-pump coronary artery bypass grafting (CABG). 9 trial fibrillation (AF) is a common complication after cardiac surgery, occurring in 10-65% of the patients. 1 Several studies have found adverse outcomes associated with postoperative AF (POAF), including increased risk of hospital stay, higher risk of stroke, permanent pacemaker implantation, and increased in-hospital and long-term mortality rates. 2 The incidence of POAF is higher with valvular surgery. 3 Obviously, in aortic valve (AV) surgery, the incidence of AF is related to these postoperative complications. 4 Moreover, Filardo et al reported that new-onset POAF was significantly associated with increased long-term risk of mortality in patients undergoing AV replacement (AVR) surgery. 5 These results indicate that POAF should be prevented and controlled postoperatively.In the past 2 decades, many clinical variables, including preoperative characteristics, comorbidities, intraoperative findings A

Preoperative Tissue Doppler Imaging-Derived Atrial Conduction Time Predicts Postoperative Atrial Fibrillation in Patients Undergoing Mitral Valve Surgery for Mitral Valve Regurgitation

“…6 In our previous study in patients undergoing off-pump CABG and aortic valve surgery, the optimal PA-TDI duration cut-offs for predicting POAF were 141 and 147.3 ms, respectively. 7, 8 In the present study, we found that the optimal cut-off for PA-TDI duration was >159.4 ms. The difference in optimal PA-TDI cut-off may be related to the size of the LA and degree of surgical manipulation, and thus the optimal cut-off should be evaluated separately.…”

“…15 In the present study, there was no significant difference in LAVI between patients with and without POAF, but LAVI in both groups was larger than that in previous reports, and both groups in the present study had an increased risk of POAF. 3,7, 8 TACT is defined as the time between the initial and the last portion of the atrial myocardium to depolarize, which usually reflects the interval from the sinus node to LA wall activation, and this was discussed in our previous reports. 5,7,8 Theoretically, TACT is measured by the duration of the P wave on 12-lead surface ECG, but there are several reports that measured TACT on echocardiography.…”

“…5,7,8 Theoretically, TACT is measured by the duration of the P wave on 12-lead surface ECG, but there are several reports that measured TACT on echocardiography. 7, 8 The PA-TDI duration used in the present study was described by Merckx et al and was measured only in tissue Doppler mode on echocardiography. 5 They also mentioned that PA-TDI duration included the time for propagation of the impulse to the LA as well as the time required for mechanical coupling of the LA; therefore, the PA-TDI interval overestimates TACT.…”

“…19 Our previous studies also showed that PA-TDI duration was an independent predictor of POAF in patients undergoing off-pump CABG and aortic valve surgery. 7, 8 The aim of the present study was to determine the optimal cut-off of PA-TDI duration to predict POAF in patients with MR. In an outpatient clinical study, de Vos et al showed that PA-TDI duration (OR, 1.04; 95% CI: 1.01-1.07; P=0.0048) were significant independent predictors of POAF.…”

“…5, 6 Our previous studies showed that PA-TDI duration was predictive of AF in patients undergoing off-pump CABG and aortic valve surgery. 7, 8 The present study therefore evaluate the efficacy of ostoperative atrial fibrillation (POAF) is a common complication after cardiac surgery, occurring in 10-65% of patients. 1 Several studies have shown that POAF is associated with longer hospital stay, higher risk of stroke, permanent pacemaker implantation, and increased inhospital and long-term mortality.…”