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NON-INVASIVE ELECTROPHYSIOLOGICAL EVALUATION OF NEW-ONSET ATRIAL FIBRILLATION AFTER CARDIAC SURGERY: PRELIMINARY RESULTS

New-onset atrial fibrillation after cardiac surgery (NOAF) is a frequent complication and is associated with postoperative stroke, increased mortality, prolonged hospital length of stay, and higher treatment costs. The structures maintaining NOAF are mainly unknown. Thus, the present study aims to d...

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Bibliographic Details
Published in:Journal of cardiothoracic and vascular anesthesia 2024-12, Vol.38 (12), p.3-4
Main Authors: Amacher, Simon, Gahl, Brigitta, Miazza, Jules, Koechlin, Luca, Berdajs, Denis, Cueni, Nadine, Kühne, Michael, Mueller, Christian, Sticherling, Christian, Osswald, Stefan, Reuthebuch, Oliver, Siegemund, Martin, Eckstein, Friedrich, Hollinger, Alexa, Santer, David
Format: Article
Language:English
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Summary:New-onset atrial fibrillation after cardiac surgery (NOAF) is a frequent complication and is associated with postoperative stroke, increased mortality, prolonged hospital length of stay, and higher treatment costs. The structures maintaining NOAF are mainly unknown. Thus, the present study aims to describe electrophysiological patterns of NOAF that might be future therapeutic targets. We present preliminary data from an ongoing prospective single-center cohort study of patients developing NOAF. We have included consecutive patients undergoing cardiac surgery and monitored them for the first seven postoperative days for the development of NOAF. Patients presenting with NOAF underwent non-invasive electrophysiological mapping using a 252-electrocardiogram vest to identify focal and rotational potential drivers (PDs) of NOAF. After mapping, a computed tomography scan of the chest was performed to generate a 3-dimensional model of the atria, where the PDs were projected, thus allowing a visual identification of NOAF maintaining structures. The primary outcome was the electrophysiological description of PDs of NOAF and NOAF-maintaining structures within the atria. Of 205 enrolled patients, 62 (30%) developed NOAF. Electrophysiological mapping was performed in 23 NOAF patients (37%). A median of 29 (21-48[IQR]) rotational PDs and a median of 26 (20-35[IQR]) focal PDs were identified per patient. The most frequent localizations of rotational drivers were the upper half of the right atrium (23 patients, 100%), the inferior/posterior left atrium (22 patients, 96%), and the left pulmonary veins (22 patients, 96%). The most frequent localizations of focal drivers were the upper half of the right atrium (22 patients, 96%), the left (22 patients, 96%), and right pulmonary veins (20 patients, 87%). Based on these preliminary results, structures such as the upper right atrium might play a role in maintaining NOAF and thus be targets for future preventive or therapeutic strategies. As the study is ongoing with the opening of a second study center in 2024, more precise results allowing identification of risk factors for specific PD locations and associations with outcomes are expected.
ISSN:1053-0770
DOI:10.1053/j.jvca.2024.09.023