Abstract 808: Elevated Left Ventricular End Diastolic Pressure Predicts New-onset Atrial Fibrillation Following Cardiac Surgery: A Community-based Study
Introduction Atrial fibrillation (AF) is a common complication after cardiac surgery. It is known that abnormal ventriculovascular coupling is a mechanism underlying heart failure. Therefore, we hypothesized that elevated left ventricular end diastolic pressure (LVEDP) may contribute to the development of new-onset postoperative AF (POAF) by increasing ventricular filling pressures and left atrial volume overload.
Methods We studied all Olmsted County, MN, residents in sinus rhythm without any history of preoperative AF who had invasively measured LVEDP within 3 months prior to CABG and/or valvular surgery between January 1, 2000, and December 31, 2005 (n=216). We aimed to investigate the relationship between LVEDP and the risk of developing AF (any AF episode) within 30 days of cardiac surgery.
Results The incidence of POAF was 36.3% (n=78). Patients with POAF were significantly older (69.3±9.3 vs 61±11 years, p<0.0001) and had higher LVEDP (20±9 vs 17±8 mmHg, p=0.006) than those without POAF. In multivariate logistic regression analysis, LVEDP ≥20 was associated with a 2.4 fold-increase in the risk of POAF, (OR=2.37, 95% CI [1.22 to 4.67]; p=0.010), independently of age, gender, baseline clinical and surgical risk factors, including LV ejection fraction. Age and LVEDP were the only independent predictors of POAF (OR= 1.08, 95% CI [1.04 –1.12]; p<0.0001) and (OR= 1.05, 95% CI [1.01–1.09]; p=0.03, respectively.
Conclusions Invasively measured LVEDP is a strong independent predictor of first occurrence AF after cardiac surgery. LVEDP may be used to identify high risk individuals in the community who could be targeted for prophylactic drug therapy to reduce the risk of POAF.