Introduction
The most common arrhythmia following cardiac surgery is atrial
fibrillation (AF), and its incidence is 20-40%. Despite advances in
surgical techniques and myocardial protection methods, and innovations
in anesthesia, postoperative atrial fibrillation (PoAF) is still common
after coronary artery bypass grafting (CABG) especially due to the
advanced age of the patient population (1). It is known that predicting
PoAF development prior to operation provides a significant reduction in
morbidity, mortality and hospitalization times (2,3). The
pathophysiology of PoAF is multifactorial. Although it is considered
that it develops due to advanced age, electrolyte imbalance,
hypertension, atrial fibrosis, atrial adhesions, intraoperative
ischemia, increase in postoperative sympathetic activity, and volume
loading, its pathophysiology has not yet been explained fully. For this
reason, there is no proven prophylactic treatment strategy (4,5).
Atrial electromechanical delay (AEMD) defines the time interval between
the initial point of P wave in 12-led electrocardiography (ECG) and the
formation of the late diastolic wave in Tissue Doppler Imaging (TDI).
This delay between the electrical stimulation and mechanical
contraction, in other words, atrial electrophysiological changes, cause
AF development by affecting the anatomy of atrium (6). Our aim in this
study was to investigate the predictive value of AEMD duration, which
can be easily detected by pre-operatively routinely performed ECG and
transthoracic echocardiography (TTE) (using TDI), in the development of
PoAF in isolated CABG patients.
Material
and Methods
Patients
and study design
The
data of 93 patients who underwent cardiopulmonary bypass (CPB) with
isolated CABG between October 2016 and May 2017 were examined in this
prospective study. Our study was approved by the Ethics Board of
Clinical Research of University of Health Sciences Bursa Yuksek Ihtisas
Training and Research Hospital; and the written consents of the patients
who were included in the study were obtained.
The patients between the ages of 18 and 80, scheduled for isolated CABG
and who had sinus rhythm were included in the study. Those with valvular
heart disease requiring surgical intervention, those who had previously
undergone open heart surgery, those with severe low left ventricular
ejection fraction (EF) (EF <35%), those with severe cardiac
segmental wall activity abnormalities, those with severely dilated left
atrium (LA > 50 mm), those with a history of ablation due
to AF, those with preoperative\sout, bradyarrhythmia or
tachyarrhythmia were not included in the study.
In total, 120 patients were evaluated in this study, and 93 patients met
the study criteria. Seven patients with poor image quality, 4 patients
with arrhythmia before the procedure, 5 patients with severe valve
dysfunction, 7 patients who were given antiarrhythmic during or after
the procedure, were excluded from the study.
The demographic characteristics, comorbidities, preoperative and
postoperative laboratory parameters, preoperative TTE parameters,
preoperative AEMD values, perioperative and postoperative variables of
the patients were recorded.