Pre-Operative Left Atrial Mechanical Function Predicts Risk of Atrial Fibrillation Following Cardiac Surgery

Objectives The purpose of this study was to examine whether left atrial (LA) mechanical function, as measured by LA total emptying fraction (TEF), is a predictor for the development of post-operative atrial fibrillation (POAF) following cardiac surgery. Background POAF is an important and frequent complication of cardiac surgery. LA enlargement has been reported to be a risk factor for POAF, but the relationship between LA mechanical function and POAF is not well understood. We examined the relationship between pre-operative LA function and POAF in patients without a history of atrial fibrillation. Methods A total of 101 subjects (mean age 64 ± 13 years) underwent pre-operative transthoracic echocardiograms and were followed for occurrence of POAF during the hospitalization for cardiac surgery. The left atrial maximum volume (LAVmax) and left atrial minimum volume (LAVmin) were measured and indexed to body surface area (LAVmaxI and LAVminI, respectively). LA TEF was calculated as: {[(LAVmax – LAVmin)/LAVmax] × 100%}. Univariate and multivariate analyses examined clinical and echocardiographic predictors of POAF. Results POAF occurred in 41% of subjects. Mean LA TEF was 49 ± 15%, mean LAVmaxI was 38 ± 15 ml/m2 , and mean LAVminI was 20 ± 13 ml/m2 . Age, LA TEF, and LAVminI were independent predictors of POAF. LA TEF was lower in patients with POAF compared with those without POAF (43 ± 15% vs. 55 ± 13%, p < 0.001), and patients with a LA TEF 32 ml/m2 , LA TEF