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Updated: Mar 9, 2026
Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure
Published on: February 8, 2022
Echocardiography is useful to predict postoperative atrial fibrillation in patients undergoing isolated coronary
Julien Magne1,2, Baptiste Salerno1, Dania Mohty1,2
11 CHU Limoges, Hôpital Dupuytren, Service Cardiologie, France.
Insights
Postoperative atrial fibrillation after coronary artery bypass graft is predictable. History of atrial fibrillation and left atrial volume are key indicators, improving risk identification for targeted prevention strategies.
Area of Science:
- Cardiology
- Cardiac Surgery
- Medical Imaging
Background:
- Postoperative atrial fibrillation (POAF) is a frequent complication after coronary artery bypass graft (CABG) surgery.
- Accurate prediction of POAF is crucial for implementing preventative measures and improving patient outcomes.
Purpose of the Study:
- To evaluate the predictive value of transthoracic echocardiography, in addition to clinical and ECG data, for POAF after CABG.
- To identify independent predictors of POAF in patients undergoing isolated CABG.
Main Methods:
- Prospective study of 169 patients undergoing isolated CABG, in sinus rhythm preoperatively.
- Collection of clinical, biological, ECG, and transthoracic echocardiography data within 24 hours before surgery.
- Continuous monitoring for POAF during the first five days post-surgery, with subsequent daily ECGs.
Main Results:
- POAF occurred in 38% of patients.
- Independent predictors identified were a history of atrial fibrillation (OR=6.1) and indexed maximal left atrial volume (OR=1.13).
- Incorporating echocardiographic parameters significantly improved the predictive model's value (χ² from 34 to 57).
Conclusions:
- A history of atrial fibrillation and indexed maximal left atrial volume are strong predictors of POAF post-CABG.
- These factors can help identify high-risk patients for targeted interventions.
- Echocardiography enhances the prediction of POAF, aiding in clinical decision-making.
Objective::
Postoperative atrial fibrillation is a major complication following coronary artery bypass graft. We hypothesized that, beyond clinical and electrocardiogram (ECG) data, transthoracic echocardiography could improve the prediction of postoperative atrial fibrillation.
Methods::
We prospectively studied 169 patients in sinus rhythm who underwent isolated coronary artery bypass graft in our institution. Clinical, biological, ECG and transthoracic echocardiography data were collected within 24 h before surgery. The patients were continuously monitored during the first five days, and then had daily 12-lead ECG afterwards until discharge. Postoperative atrial fibrillation was defined by any episode >10 min.
Results::
Postoperative atrial fibrillation was found in 65 patients (38%). Compared with those without, patients with postoperative atrial fibrillation were significantly older ( p=0.008), had more frequently a history of hypertension ( p=0.009), history of atrial fibrillation ( p<0.001) and New York Heart Association class ⩾III ( p=0.004). They also had longer PR interval ( p=0.005), higher preoperative NT-pro brain natriuretic peptide level ( p=0.006), left ventricle end-diastolic volume ( p=0.002), indexed left ventricle mass ( p<0.0001), indexed maximal left atrial volume ( p<0.0001), maximal right atrial area ( p<0.001) and lower left ventricle ejection fraction ( p=0.04). In multivariate analysis, history of atrial fibrillation (odds ratio =6.1, 95% confidence interval: 1.4-26.0, p=0.02) and indexed maximal left atrial volume (odds ratio =1.13, 95% confidence interval: 1.1-1.2, p=0.001) were the only two independent predictive factors of postoperative atrial fibrillation. The addition of echocardiographic parameters improved the predictive value (χ2) of the model, from 34 to 57.
Conclusion::
A history of atrial fibrillation and indexed left atrial maximal volume are the best predictors of the occurrence of postoperative atrial fibrillation following coronary artery bypass graft. The identification of high risk population of postoperative atrial fibrillation using these two factors could lead to the development of targeted strategies to limit this frequent complication in these patients.
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