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Intraoperative identification of cardiac patients at risk to develop postoperative atrial fibrillation
J E Lowe1, P J Hendry, S C Hendrickson
1Department of Surgery, Duke University Medical Center, Durham, North Carolina 27710.
Insights
A new electrophysiologic screening test can identify patients at risk for postoperative atrial fibrillation (AF) after cardiac surgery. This allows for targeted prophylactic therapy, potentially reducing complications and hospital costs.
Area of Science:
- Cardiology
- Cardiac Surgery
- Electrophysiology
Background:
- Postoperative atrial fibrillation (AF) is a common complication after cardiac surgery, increasing morbidity and healthcare costs.
- Current methods for predicting AF risk are insufficient, leading to broad prophylactic treatment strategies.
Purpose of the Study:
- To develop and validate a novel intraoperative electrophysiologic screening test to identify patients at high risk for developing postoperative AF.
- To assess the sensitivity, specificity, and predictive values of this new screening test.
Main Methods:
- A cohort of 50 patients undergoing cardiac surgery were tested pre-bypass by stimulating the mid-right atrium with increasing electrical current.
- Atrial fibrillation (AF) inducibility was recorded, and patients were monitored postoperatively for AF development.
Main Results:
- The screening test demonstrated high sensitivity (0.94) and negative predictive value (0.93) for postoperative AF.
- While specificity (0.41) and positive predictive value (0.47) were lower, inducible AF correlated with older age and longer ICU stays.
- 17 out of 18 patients who developed AF had inducible AF, while 13 out of 32 AF-free patients had negative tests.
Conclusions:
- The intraoperative electrophysiologic screening test is a promising tool for identifying patients likely to develop postoperative AF.
- This targeted approach may enable more efficient prophylactic therapy, benefiting at-risk patients and optimizing resource allocation.
Abstract:
Postoperative atrial fibrillation (AF) is a complication occurring in 11% to 36% of patients after cardiac operations, which results in increased morbidity and hospital costs. A new electrophysiologic screening test was developed to identify those patients at risk for development of postoperative AF. The test was validated in 50 patients (43 men and 7 women) with a mean age of 59.6 +/- 1.3 years who underwent coronary artery bypass grafting with or without other cardiac surgical procedures. After aortic and venous cannulation, but before initiation of bypass, the mid-right atrium was stimulated with a bipolar probe at 25 microA for 3 seconds. Alternating current was increased by 25 microA until AF was induced or up to a maximum of 200 microA. Postoperative AF occurred in 18 patients (36%), 17 of whom had inducible AF (sensitivity = 0.94). Of the remaining 32 AF-free patients, 13 had negative tests (specificity = 0.41). Age and sex were not factors affecting inducibility, although patients who developed AF were older than those who were AF free (63.6 versus 57.3 years, p = 0.02). Length of stay in the intensive care unit was longer for those with postoperative AF than for AF-free patients (3.6 versus 1.9 days, p = 0.02). The negative predictive value of the test was 0.93, and the positive value was 0.47. These data show that this new intraoperative technique may be used to identify patients at risk for postoperative AF. Prophylactic therapy can therefore be directed to only those patients at risk for postoperative AF.