Clinical Predictors of Device-Detected Atrial Fibrillation During 2.5 Years After Cardiac Surgery : Prospective RACE V Cohort
Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved..
BACKGROUND: 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.
OBJECTIVES: 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.
METHODS: 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.
RESULTS: 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 (RAVImin) and early-POAF were independently associated with late-POAF. A prediction model for late-POAF, which included RAVImin >11 mL/m2, 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 RAVImin was independently associated with a higher incidence of late-POAF.
CONCLUSIONS: 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].
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - year:2024 |
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| Enthalten in: |
JACC. Clinical electrophysiology - (2024) vom: 28. Feb. |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Gilbers, Martijn D [VerfasserIn] |
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| Links: |
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| Themen: |
Cardiac surgery |
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| Anmerkungen: |
Date Revised 14.03.2024 published: Print-Electronic ClinicalTrials.gov: NCT03124576 Citation Status Publisher |
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| doi: |
10.1016/j.jacep.2024.01.013 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM369731174 |
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| 100 | 1 | |a Gilbers, Martijn D |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Clinical Predictors of Device-Detected Atrial Fibrillation During 2.5 Years After Cardiac Surgery |b Prospective RACE V Cohort |
| 264 | 1 | |c 2024 | |
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| 500 | |a ClinicalTrials.gov: NCT03124576 | ||
| 500 | |a Citation Status Publisher | ||
| 520 | |a Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved. | ||
| 520 | |a BACKGROUND: 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 | ||
| 520 | |a OBJECTIVES: 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 | ||
| 520 | |a METHODS: 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 | ||
| 520 | |a RESULTS: 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 (RAVImin) and early-POAF were independently associated with late-POAF. A prediction model for late-POAF, which included RAVImin >11 mL/m2, 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 RAVImin was independently associated with a higher incidence of late-POAF | ||
| 520 | |a CONCLUSIONS: 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] | ||
| 650 | 4 | |a Journal Article | |
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| 700 | 1 | |a Kawczynski, Michal J |e verfasserin |4 aut | |
| 700 | 1 | |a Bidar, Elham |e verfasserin |4 aut | |
| 700 | 1 | |a Maesen, Bart |e verfasserin |4 aut | |
| 700 | 1 | |a Isaacs, Aaron |e verfasserin |4 aut | |
| 700 | 1 | |a Winters, Joris |e verfasserin |4 aut | |
| 700 | 1 | |a Linz, Dominik |e verfasserin |4 aut | |
| 700 | 1 | |a Rienstra, Michiel |e verfasserin |4 aut | |
| 700 | 1 | |a van Gelder, Isabelle |e verfasserin |4 aut | |
| 700 | 1 | |a Maessen, Jos G |e verfasserin |4 aut | |
| 700 | 1 | |a Schotten, Ulrich |e verfasserin |4 aut | |
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