Predicting Post-operative Atrial Fibrillation in Cardiac Surgery – The Added Value of Echocardiography

Main Article Content

Marija Gjerakaroska-Radovikj
Vasil Papestiev
Sashko Jovev


INTRODUCTION: Post-operative atrial fibrillation (POAF) is a frequent rhythmic complication in cardiac surgery with the potential to cause sudden hemodynamic instability and catastrophic thromboembolic complications. Despite vast scientific research, it is still hard to predict and prevents its occurrence.

AIM: The aim of this study was to determine whether selected pre-operative and intraoperative echocardiographic variables would be of added value in POAF prediction.

МАTERIAL AND METHODS: This prospective observational follow-up study included 178 cardiac surgery patients undergoing coronary artery bypass graft intervention. Demographic as well as echocardiographic variables of interest were examined to detect significant independent predictors for POAF.

RESULTS: POAF was detected in 90 (50.56%) patients versus 88 (49.44%) patients without POAF. Patients who developed POAF were significantly older and burdened with multiple comorbidities. In multiple regression analysis pre-operative echocardiographic variables-diastolic dysfunctions, enlarged left atrial (LA) volume indexed for body surface area, mitral annular calcification, and secondary mitral regurgitation were predictive of POAF. LA appendage flow velocity obtained by intraoperative transesophageal echocardiography was also a significant intraoperative predictor for POAF.

CONCLUSION: The results of this study confirmed that two-dimensional echocardiography is a valuable diagnostic and prognostic tool in relation to POAF. The addition of the aforementioned echocardiographic independent predictors to traditional demographic variables could be a solid foundation of a new predictive model for POAF.


Download data is not yet available.

Article Details

How to Cite
Gjerakaroska-Radovikj, M., Papestiev, V., & Jovev, S. (2021). Predicting Post-operative Atrial Fibrillation in Cardiac Surgery – The Added Value of Echocardiography. South East European Journal of Cardiology, 2(1), 1–6.
Cardiovascular Surgery


Frendl G, Sodickson AC, Chung MK, Waldo AL, Gersh BJ, Tisdale JE, et al. 2014 AATS guidelines for the prevention and management of perioperative atrial fibrillation and flutter for thoracic surgical procedures. J Thorac Cardiovasc Surg. 2014;148(3):e153-93. PMid:25129609 DOI:

Rezaei Y, Peighambari MM, Naghshbandi S, Samiei N, Ghavidel AA, Dehghani MR, et al. Postoperative atrial fibrillation following cardiac surgery: From pathogenesis to potential therapies. Am J Cardiovasc Drugs. 2020;20(1):19-49. PMid:31502217 DOI:

Gudbjartsson T, Helgadottir S, Sigurdsson MI, Taha A, Jeppsson A, Christensen TD, et al. New-onset postoperative atrial fibrillation after heart surgery. Acta Anaesthesiol Scand. 2020;64(2):145-55. PMid:31724159 DOI:

Almassi GH, Pecsi SA, Collins JF, Shroyer AL, Zenati MA, GroverFL. Predictors and impact of postoperative atrial fibrillation on patients’ outcomes: A report from the randomized on versus off bypass trial. J Thorac Cardiovasc Surg. 2012;143(1):93-102. PMid:22054659 DOI:

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. PMid:8759081 DOI:

Mathew JP, Fontes ML, Tudor IC, Ramsay J, Duke P, Mazer CD, et al. A multicenter risk index for atrial fibrillation after cardiac surgery. JAMA. 2004;291(14):1720-9. PMid:15082699 DOI:

Maisel WH, Rawn JD, Stevenson WG. Atrial fibrillation after cardiac surgery. Ann Intern Med. 2001;135(12):1061-73. PMid:11747385 DOI:

Creswell LL, Schuessler RB, Rosenbloom M, Cox JL. Hazards of postoperative atrial arrhythmias. Ann Thorac Surg. 1993;56(3):539-49. PMid:8379728 DOI:

Frost L, Molgaard H, Christiansen EH, Jacobsen CJ, Pilegaard H, Thomsen PE. Atrial ectopic activity and atrial fibrillation/fiutter after coronary artery bypass surgery; a case-base study controlling for the confounding from age, б-blocker treatment, and the time distance from operation. Int J Cardiol. 1995;50(2):153-62. PMid:7591326 DOI:

Amar D, Zhang H, Leung D, Alan H, Kadish A. Older Age is the strongest predictor of postoperative atrial fibrillation. Anesthesiology. 2002;96:352-6. PMid:11818768 DOI:

Franczyk B, Gluba-Brzózka A, Ciałkowska-Rysz A, Banach M, Rysz J. the problem of atrial fibrillation in patients with chronic kidney disease. Curr Vasc Pharmacol. 2016;14(3):260-5. https:// PMid:26769703 DOI:

Alonso A, Lopez FL, Matsushita K, Loehr LR, Agarwal SK, Chen Y, et al. Chronic kidney disease is associated with the incidence of atrial fibrillation: The atherosclerosis risk in communities (ARIC) study. Circulation. 2011;123(25):2946-53. PMid:21646496 DOI:

Violi F, Soliman ZE, Pignatelli P, Pastori D. Atrial fibrillation and myocardial infarction: A systematic review and appraisal of pathophysiologic mechanisms. J Am Heart Assoc. 2016;5(5):e003347. PMid:27208001 DOI:

Shah V, Desai T, Agrawal A. The association between chronic obstructive pulmonary disease (COPD) and atrial fibrillation: A review. Chron Obstruct Pulmon Dis. 2016;1:2. DOI:

Goudis CA. Chronic obstructive pulmonary disease and atrial fibrillation: An unknown relationship. J Cardiol. 2017;69(5):699-705. PMid:28188041 DOI:

Hashemzadeh K, Dehdilani M, Dehdilani M. Postoperative atrial fibrillation following open cardiac surgery: Predisposing factors and complications. J Cardiovasc Thorac Res. 2013;5(3):101-7. PMid:24252985

Sood A, Toth A, Abdallah M, Gillinov M, Milind D, Allan K, et al. Temporal trend and associated risk factors for new-onset atrial fibrillation following cardiac valve surgery. J Atr Fibrillation. 2020;12(6):2129. PMid:33024483 DOI:

Ito T, Suwa M, Hirota Y, Otake Y, Moriguchi A, Kawamura K. Influence of left atrial function on Doppler transmitral and pulmonary venous flow patterns in dilated and hypertrophic cardiomyopathy: Evaluation of left atrial appendage function by transesophageal echocardiography. Am Heart J. 1996;131(1):122-30. PMid:8553998 DOI:

Ngai J, Leonard J, Echevarria G, Neuburger P, Applebaum R. Left atrial appendage velocity as a predictor of atrial fibrillation after cardiac surgery. J Cardiothorac Vasc Anesth. 2016;30(2):413-7. PMid:26706710 DOI:

Sarin K, Chauhan S, Bisoi AK, Kapoor PM, Gharde P, Choudhury A. Relationship between perioperative left atrial appendage Doppler velocity estimates and new-onset atrial fibrillation in patients undergoing coronary artery bypass graft surgery with cardiopulmonary bypass. Ann Card Anaesth. 2017;20(4):403-7. PMid:28994674 DOI:

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. PMid:16904549 DOI:

Tsang TS, Barnes ME, Bailey KR, Leibson CL, Montgomery SC, Takemoto Y, et al. Left atrial volume: Important risk marker of incident atrial fibrillation in 1655 older men and women. Mayo Clin Proc. 2001;76(5):467-75. PMid:11357793 DOI:

Appleton CP, Galloway JM, Gonzalez MS, Gaballa M, Basnight MA. Estimation of left ventricular filling pressures using twodimensional and Doppler echocardiography in adult patients with cardiac disease. Additional value of analyzing left atrial size, left atrial ejection fraction and the difference in duration of pulmonary venous and mitral flow velocity at atrial contraction. J Am Coll Cardiol. 1993;22(7):1972-82. PMid:8245357 DOI:

Melduni RM, Suri RM, Seward JB, Bailey KR, Ammash NM, Oh JK, et al. Diastolic dysfunction in patients undergoing cardiac surgery: A pathophysiological mechanism underlying the initiation of new-onset post-operative atrial fibrillation. J Am Coll Cardiol. 2011;58(9):953-61. PMid:21851885 DOI:

Barbara DW, Rehfeldt KH, Pulido JN, Li Z, White RD, Schaff HV, et al. Diastolic function and new-onset atrial fibrillation following cardiac surgery. Ann Card Anaesth. 2015;18(1):8-14. PMid:25566703 DOI:

Cameron MJ, Tran DT, Abboud J, Newton EK, Rashidian H, Dupuis JY. Prospective external validation of three preoperative risk scores for prediction of new onset atrial fibrillation after cardiac surgery. Anesth Analg. 2018;126(1):33-8. PMid:28514319 DOI:

Kievišas M, Keturakis V, Vaitiekūnas E, Dambrauskas L, Jankauskienė L, Kinduris Š. Prognostic factors of atrial fibrillation following coronary artery bypass graft surgery. Gen Thorac Cardiovasc Surg. 2017;65(10):566-74. PMid:28647801 DOI:

Li Y, Lu Z, Li X, Huang J, Wu Q. Mitral annular calcification is associated with atrial fibrillation and major cardiac adverse events in atrial fibrillation patients: A systematic review and meta-analysis. Medicine (Baltimore). 2019;98(44):e17548. PMid:31689756 DOI:

Boston Area Anticoagulation Trial for Atrial Fibrillation Investigators, Singer DE, Hughes RA, Gress DR, Sheehan MA, Oertel LB, et al. The effect of low-dose warfarin on the risk of stroke in patients with nonrheumatic atrial fibrillation. N Engl J Med. 1990;325:129-32. DOI: