Preoperative left atrial volume index may be associated with postoperative atrial fibrillation in non-cardiac surgery

Ah Ran Oh; Sung Ho Lee; Jungchan Park; Jong-Hwan Lee; Dahye Cha; Kwangmo Yang; Jin-Ho Choi; Joonghyun Ahn; Ji Dong Sung; Bogeum Choi; Seung-Hwa Lee

doi:10.3389/fcvm.2022.1008718

Preoperative left atrial volume index may be associated with postoperative atrial fibrillation in non-cardiac surgery

Front Cardiovasc Med. 2022 Nov 3:9:1008718. doi: 10.3389/fcvm.2022.1008718. eCollection 2022.

Authors

Ah Ran Oh^{1

2}, Sung Ho Lee³, Jungchan Park^{1

4}, Jong-Hwan Lee¹, Dahye Cha¹, Kwangmo Yang^{4

5}, Jin-Ho Choi⁶, Joonghyun Ahn⁷, Ji Dong Sung⁸, Bogeum Choi⁹, Seung-Hwa Lee^{8

10}

Affiliations

¹ Department of Anesthesiology and Pain Medicine, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, South Korea.
² Department of Anesthesiology and Pain Medicine, Kangwon National University Hospital, Chuncheon, South Korea.
³ Division of Cardiology, Department of Internal Medicine, Kangbuk Samsung Hospital, School of Medicine, Sungkyunkwan University, Seoul, South Korea.
⁴ Department of Biomedical Sciences, Ajou University Graduate School of Medicine, Suwon, South Korea.
⁵ Center for Health Promotion, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, South Korea.
⁶ Department of Emergency Medicine, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, South Korea.
⁷ Statistics and Data Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, South Korea.
⁸ Rehabilitation and Prevention Center, Heart Vascular Stroke Institute, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, South Korea.
⁹ College of Medicine, Kyung Hee University, Seoul, South Korea.
¹⁰ Department of Biomedical Engineering, Seoul National University College of Medicine, Seoul, South Korea.

Abstract

Background: Postoperative atrial fibrillation (POAF) is related to mortality after non-cardiac surgery. Left atrial volume index (LAVI) is known to be associated with prognosis and development of atrial fibrillation, but it has not been fully investigated in patients undergoing non-cardiac surgery.

Materials and methods: A total of 203,787 consecutive adult patients underwent non-cardiac surgery at our institution between January 2011 and June 2019. After identifying those with available LAVI estimated during preoperative echocardiography, we divided them into those with LAVI higher and lower than 34 mL/m². The primary outcome was incidence of POAF.

Results: A total of 83,097 patients were enrolled in this study. The study patients were divided into the low (57,838 [69.6%]) and high (25,259 [30.4%]) LAVI groups. After an adjustment, higher LAVI was associated with increased incidence of POAF (5.1% vs. 8.1%; odds ratio [OR], 1.33; 95% confidence interval [CI], 1.25-1.41; p < 0.001). In 24,549 pairs of propensity-score-matched population, the result was similar (6.2% vs. 7.9%; OR, 1.30; 95% CI, 1.21-1.39; p < 0.001). The estimated threshold of LAVI associated with POAF was 36.4 mL/m² with an area under the curve of 0.571. Subgroup analysis in non-thoracic and thoracic surgery showed that the association between preoperative LAVI and POAF significantly interacted with diastolic dysfunction (p for interaction < 0.001), and the observed association was valid in patients without diastolic dysfunction.

Conclusion: Preoperative LAVI was shown to be associated with POAF in non-cardiac surgery. Our result needs verification in further studies.

Keywords: atrial fibrillation; echocardiography; left atrial volume index; non-cardiac surgery; postoperative cardiac complications.