Atrial Electromehanical Interval Using Tissue Doppler as Predictor of Atrial Fibrillation After Coronary Artery Bypass Grafting
Abstract
Background. Atrial fibrillation (AF) is the most common arrhythmia complication in patient undergone coronary artery bypass grafting (CABG) with the incidence of 20-50% according to different studies. Although this complication is temporary but can be life threathening, and increased the number of mortality and morbidity. Thus, it is very important to identified factors that can predict the occurance of AF post CABG. This study use atrial electromechanical interval and interval dispertion as predictor of AF post CABG.Methods. One hundred and eight patients were included in this case control study. Samples were taken consecutively from May to September 2012 among patients with coronary artery disease undergoing CABG at the National Cardiovascular Center Harapan Kita Jakarta. The patients underwent a preoperative transthoracic echocardiography with tissue doppler evaluation. We measured the atrial electromechanical interval in the lateral of left atrium, septal and lateral of right atrium also inter and intra atrial interval dispertion. Patients was monitored thorugh out hospitalization for the occurance of AF.
Result. In our study, 27 out of 108 (25%) patients developed AF post CABG. There are 3 independent parameters that can predict AF post CABG. These parameters are electromechanical interval in lateral left atrium, left atrial volume index, and post operative beta blocker. There are longer electromechanical interval in lateral left atrium in patients with AF post CABG (81,12±9,84 ms vs 64,43±13,53 ms, P=0.00). Patients with AF had bigger left atrial volume index (37,31±9,50 ml/m2 vs 30,28±8,19 ml/m2, P=0.037) and more beta blocker post CABG (20 (74,1%) vs 72(88,9%), P=0.026). There are no difference intra and interatrium dispertion of electromechanical interval.
Conclusion. The interval of Electromechanical in the lateral left atrium using tissue dopper echocardiography can predict the occurrence of AF post CABG.
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References
Hakala T, Hedman A. Predicting the risk of atrial fibrillation after coronary artery bypass surgery. Scand Cardiovasc J. 2003; 37(6): 309-15.
Aranki SF, Shaw DP, Adams DH, Rizzo RJ, Couper GS, VanderVliet M, et al. Predictors of atrial fibrillation after coronary artery surgery. Current trends and impact on hospital resources. Circulation. 1996; 94(3): 390-7.
Creswell LL, Damiano RJ, Jr. Postoperative atrial fibrillation: an old problem crying for new solutions. J Thorac Cardiovasc Surg. 2001; 121(4): 638-41.
Mahoney EM, Thompson TD, Veledar E, Williams J, Weintraub WS. Cost-effectiveness of targeting patients undergoing cardiac surgery for therapy with intravenous amiodarone to prevent atrial fibrillation. J Am Coll Cardiol. 2002; 40(4): 737-45.
Omi W, Nagai H, Takamura M, Okura S, Okajima M, Furusho H, et al. Doppler tissue analysis of atrial electromechanical coupling in paroxysmal atrial fibrillation. J Am Soc Echocardiogr. 2005; 18(1): 39-44.
Creswell LL, Schuessler RB, Rosenbloom M, Cox JL. Hazards of postoperative atrial arrhythmias. Ann Thorac Surg. 1993; 56(3): 539-49.
Villareal RP, Hariharan R, Liu BC, Kar B, Lee VV, Elayda M, et al. Postoperative atrial fibrillation and mortality after coronary artery bypass surgery. J Am Coll Cardiol. 2004; 43(5): 742-8.
Almassi GH, Schowalter T, Nicolosi AC, Aggarwal A, Moritz TE, Henderson WG, et al. Atrial fibrillation after cardiac surgery: a major morbid event? Ann Surg. 1997; 226(4): 501-11; discussion 11-3.
Mathew JP, Parks R, Savino JS, Friedman AS, Koch C, Mangano DT, et al. Atrial fibrillation following coronary artery bypass graft surgery: predictors, outcomes, and resource utilization. MultiCenter Study of Perioperative Ischemia Research Group. JAMA. 1996; 276(4): 300-6.
Hadis H, Yuniadi Y, Idham I. Incidence and risk factors of atrial fibrillation after coronary bypass graft surgery. J Kardiol Indones. 2010; 31: 16-25.
Ariyarajah V, Mercado K, Apiyasawat S, Puri P, Spodick DH. Correlation of left atrial size with p-wave duration in interatrial block. Chest. 2005; 128(4): 2615-8.
Dilaveris PE, Gialafos EJ, Sideris SK, Theopistou AM, Andrikopoulos GK, Kyriakidis M, et al. Simple electrocardiographic markers for the prediction of paroxysmal idiopathic atrial fibrillation. Am Heart J. 1998; 135(5 Pt 1): 733-8.
Dilaveris PES, C.I. P wave dispersion: A valuable non-invasive marker of vulnerability to atrial arrhythmias. Hospital chronicles. 2006; 1(3): 130-7.
Weber UK, Osswald S, Huber M, Buser P, Skarvan K, Stulz P, et al. Selective versus non-selective antiarrhythmic approach for prevention of atrial fibrillation after coronary surgery: is there a need for pre-operative risk stratification? A prospective placebo-controlled study using low-dose sotalol. Eur Heart J. 1998; 19(5): 794-800.
Chandy J, Nakai T, Lee RJ, Bellows WH, Dzankic S, Leung JM. Increases in P-wave dispersion predict postoperative atrial fibrillation after coronary artery bypass graft surgery. Anesth Analg. 2004; 98(2): 303-10, table of contents.
Yamada T, Fukunami M, Shimonagata T, Kumagai K, Sanada S, Ogita H, et al. Dispersion of signal-averaged P wave duration on precordial body surface in patients with paroxysmal atrial fibrillation. Eur Heart J. 1999; 20(3): 211-20.
Sakabe K, Fukuda N, Fukuda Y, Morishita S, Shinohara H, Tamura Y. Interatrial dyssynchrony on tissue Doppler imaging predicts progression to chronic atrial fibrillation in patients with non-valvular paroxysmal atrial fibrillation. Heart. 2009; 95(12): 988-93.
Platonov PG. Interatrial conduction in the mechanisms of atrial fibrillation: from anatomy to cardiac signals and new treatment modalities. Europace. 2007; 9 Suppl 6: vi10-6.
Maesen B, Nijs J, Maessen J, Allessie M, Schotten U. Post-operative atrial fibrillation: a maze of mechanisms. Europace. 2012; 14(2): 159-74.
Spach MS, Dolber PC. Relating extracellular potentials and their derivatives to anisotropic propagation at a microscopic level in human cardiac muscle. Evidence for electrical uncoupling of side-to-side fiber connections with increasing age. Circ Res. 1986; 58(3): 356-71.
Goette A, Juenemann G, Peters B, Klein HU, Roessner A, Huth C, et al. Determinants and consequences of atrial fibrosis inpatients undergoing open heart surgery. Cardiovasc Res. 2002; 54(2): 390-6.
Nakai T, Lee RJ, Schiller NB, Bellows WH, Dzankic S, Reeves J, 3rd, et al. The relative importance of left atrial function versus dimension in predicting atrial fibrillation after coronary artery bypass graft surgery. Am Heart J. 2002; 143(1): 181-6.
Osranek M, Fatema K, Qaddoura F, Al-Saileek A, Barnes ME, Bailey KR, et al. Left atrial volume predicts the risk of atrial fibrillation after cardiac surgery: a prospective study. J Am Coll Cardiol. 2006; 48(4): 779-86.
Kalman JM, Munawar M, Howes LG, Louis WJ, Buxton BF, Gutteridge G, et al. Atrial fibrillation after coronary artery bypass grafting is associated with sympathetic activation. Ann Thorac Surg. 1995; 60(6): 1709-15.
Burgess DC, Kilborn MJ, Keech AC. Interventions for prevention of post-operative atrial fibrillation and its complications after cardiac surgery: a meta-analysis. Eur Heart J. 2006; 27(23): 2846-57.
Crystal E, Connolly SJ, Sleik K, Ginger TJ, Yusuf S. Interventions on prevention of postoperative atrial fibrillation in patients undergoing heart surgery: a meta-analysis. Circulation. 2002; 106(1): 75-80.
Aranki SF, Shaw DP, Adams DH, Rizzo RJ, Couper GS, VanderVliet M, et al. Predictors of atrial fibrillation after coronary artery surgery. Current trends and impact on hospital resources. Circulation. 1996; 94(3): 390-7.
Creswell LL, Damiano RJ, Jr. Postoperative atrial fibrillation: an old problem crying for new solutions. J Thorac Cardiovasc Surg. 2001; 121(4): 638-41.
Mahoney EM, Thompson TD, Veledar E, Williams J, Weintraub WS. Cost-effectiveness of targeting patients undergoing cardiac surgery for therapy with intravenous amiodarone to prevent atrial fibrillation. J Am Coll Cardiol. 2002; 40(4): 737-45.
Omi W, Nagai H, Takamura M, Okura S, Okajima M, Furusho H, et al. Doppler tissue analysis of atrial electromechanical coupling in paroxysmal atrial fibrillation. J Am Soc Echocardiogr. 2005; 18(1): 39-44.
Creswell LL, Schuessler RB, Rosenbloom M, Cox JL. Hazards of postoperative atrial arrhythmias. Ann Thorac Surg. 1993; 56(3): 539-49.
Villareal RP, Hariharan R, Liu BC, Kar B, Lee VV, Elayda M, et al. Postoperative atrial fibrillation and mortality after coronary artery bypass surgery. J Am Coll Cardiol. 2004; 43(5): 742-8.
Almassi GH, Schowalter T, Nicolosi AC, Aggarwal A, Moritz TE, Henderson WG, et al. Atrial fibrillation after cardiac surgery: a major morbid event? Ann Surg. 1997; 226(4): 501-11; discussion 11-3.
Mathew JP, Parks R, Savino JS, Friedman AS, Koch C, Mangano DT, et al. Atrial fibrillation following coronary artery bypass graft surgery: predictors, outcomes, and resource utilization. MultiCenter Study of Perioperative Ischemia Research Group. JAMA. 1996; 276(4): 300-6.
Hadis H, Yuniadi Y, Idham I. Incidence and risk factors of atrial fibrillation after coronary bypass graft surgery. J Kardiol Indones. 2010; 31: 16-25.
Ariyarajah V, Mercado K, Apiyasawat S, Puri P, Spodick DH. Correlation of left atrial size with p-wave duration in interatrial block. Chest. 2005; 128(4): 2615-8.
Dilaveris PE, Gialafos EJ, Sideris SK, Theopistou AM, Andrikopoulos GK, Kyriakidis M, et al. Simple electrocardiographic markers for the prediction of paroxysmal idiopathic atrial fibrillation. Am Heart J. 1998; 135(5 Pt 1): 733-8.
Dilaveris PES, C.I. P wave dispersion: A valuable non-invasive marker of vulnerability to atrial arrhythmias. Hospital chronicles. 2006; 1(3): 130-7.
Weber UK, Osswald S, Huber M, Buser P, Skarvan K, Stulz P, et al. Selective versus non-selective antiarrhythmic approach for prevention of atrial fibrillation after coronary surgery: is there a need for pre-operative risk stratification? A prospective placebo-controlled study using low-dose sotalol. Eur Heart J. 1998; 19(5): 794-800.
Chandy J, Nakai T, Lee RJ, Bellows WH, Dzankic S, Leung JM. Increases in P-wave dispersion predict postoperative atrial fibrillation after coronary artery bypass graft surgery. Anesth Analg. 2004; 98(2): 303-10, table of contents.
Yamada T, Fukunami M, Shimonagata T, Kumagai K, Sanada S, Ogita H, et al. Dispersion of signal-averaged P wave duration on precordial body surface in patients with paroxysmal atrial fibrillation. Eur Heart J. 1999; 20(3): 211-20.
Sakabe K, Fukuda N, Fukuda Y, Morishita S, Shinohara H, Tamura Y. Interatrial dyssynchrony on tissue Doppler imaging predicts progression to chronic atrial fibrillation in patients with non-valvular paroxysmal atrial fibrillation. Heart. 2009; 95(12): 988-93.
Platonov PG. Interatrial conduction in the mechanisms of atrial fibrillation: from anatomy to cardiac signals and new treatment modalities. Europace. 2007; 9 Suppl 6: vi10-6.
Maesen B, Nijs J, Maessen J, Allessie M, Schotten U. Post-operative atrial fibrillation: a maze of mechanisms. Europace. 2012; 14(2): 159-74.
Spach MS, Dolber PC. Relating extracellular potentials and their derivatives to anisotropic propagation at a microscopic level in human cardiac muscle. Evidence for electrical uncoupling of side-to-side fiber connections with increasing age. Circ Res. 1986; 58(3): 356-71.
Goette A, Juenemann G, Peters B, Klein HU, Roessner A, Huth C, et al. Determinants and consequences of atrial fibrosis inpatients undergoing open heart surgery. Cardiovasc Res. 2002; 54(2): 390-6.
Nakai T, Lee RJ, Schiller NB, Bellows WH, Dzankic S, Reeves J, 3rd, et al. The relative importance of left atrial function versus dimension in predicting atrial fibrillation after coronary artery bypass graft surgery. Am Heart J. 2002; 143(1): 181-6.
Osranek M, Fatema K, Qaddoura F, Al-Saileek A, Barnes ME, Bailey KR, et al. Left atrial volume predicts the risk of atrial fibrillation after cardiac surgery: a prospective study. J Am Coll Cardiol. 2006; 48(4): 779-86.
Kalman JM, Munawar M, Howes LG, Louis WJ, Buxton BF, Gutteridge G, et al. Atrial fibrillation after coronary artery bypass grafting is associated with sympathetic activation. Ann Thorac Surg. 1995; 60(6): 1709-15.
Burgess DC, Kilborn MJ, Keech AC. Interventions for prevention of post-operative atrial fibrillation and its complications after cardiac surgery: a meta-analysis. Eur Heart J. 2006; 27(23): 2846-57.
Crystal E, Connolly SJ, Sleik K, Ginger TJ, Yusuf S. Interventions on prevention of postoperative atrial fibrillation in patients undergoing heart surgery: a meta-analysis. Circulation. 2002; 106(1): 75-80.
Published
2014-03-03
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How to Cite
Yansen, I., Mardiani, A., & Roebiono, P. (2014). Atrial Electromehanical Interval Using Tissue Doppler as Predictor of Atrial Fibrillation After Coronary Artery Bypass Grafting. Indonesian Journal of Cardiology, 34(2), 81-91. https://doi.org/10.30701/ijc.v34i2.325
Section
Clinical Research
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