Relationship Between Right Ventricular Function and Atrial Fibrillation After Cardiac Surgery

Objective: The aim of this study was to explore the relationship between perioperative right ventricular (RV) function and postoperative atrial fibrillation (POAF) in the context of cardiac surgery.

Design: Prospective, observational study.

Setting: A single medical center setting.

Participants: The study comprised 92 patients undergoing elective cardiac surgery.

Interventions: None.

Measurements and main results: Consecutive patients without previous history of atrial fibrillation referred for cardiac surgery were enrolled prospectively. Comprehensive transesophageal echocardiography was recorded at the following 2 specific timeframes: before sternotomy (T1) and after sternal closure (T2). Four RV measurements, including RV global longitudinal strain (RVGLS), were performed offline. POAF was defined as any sustained episode of atrial fibrillation recorded within 14 days postoperatively. Ninety-two patients (mean age 61.2 ± 10.8 yr, 63 men) were included in this study; 25 patients (27%) experienced POAF, with a median occurrence of 3 days after cardiac surgery. Multivariable logistic regression models demonstrated that RVGLS_T1 (odds ratio 1.13, p = 0.047) and RVGLS_T2 (odds ratio 1.38, p = 0.001) were associated independently with POAF. However, changes in RV indices were not correlated to POAF. The optimal cutoff points obtained from the receiver operating characteristic curve analysis were as follows: -16.7% of RVGLS_T1 (positive likelihood ratio 2.21, negative likelihood ratio 0.59) and -16.1% of RVGLS_T2 (positive likelihood ratio 2.68, negative likelihood ratio 0.38).

Conclusions: RV dysfunction is associated significantly with the occurrence of POAF in the context of cardiac surgery, and perioperative RVGLS measured using transesophageal echocardiography is a useful index to predict POAF in patients referred for cardiac surgery.