Diastolic dysfunction in patients undergoing cardiac surgery: A pathophysiological mechanism underlying the initiation of new-onset post-operative atrial fibrillation

Objectives: Our goal was to investigate whether left ventricular (LV) diastolic dysfunction was an important pathophysiological mechanism underlying the initiation of new-onset post-operative atrial fibrillation (POAF). Background: Atrial fibrillation is a common complication after cardiac surgery. However, the precise mechanism underlying its development remains poorly understood. Pre-existing alterations of myocardial diastolic function may predispose patients to the development of POAF. Methods: Patients were residents of Olmsted County, Minnesota, who underwent complete LV diastolic function assessment before coronary artery bypass grafting and/or valve surgery between January 1, 2000, and December 31, 2005. All were in sinus rhythm and had no history of atrial fibrillation, a pacemaker, mitral stenosis, or congenital heart disease. POAF was defined as any episode of atrial fibrillation within 30 days after surgery. Results: POAF occurred in 135 of 351 patients (38.5%). Patients with POAF were older (mean age 72.5 ± 10.3 years vs. 63.1 ± 14.1 years; p < 0.001) and more likely to have abnormal diastolic function. The rate of POAF increased exponentially with diastolic function grade (DFG) severity (p < 0.001). By multivariate analysis, after adjusting for clinical and surgical risk factors, independent predictors of POAF were older age (odds ratio [OR]: 1.05; p < 0.001), higher body mass index (OR: 1.06; p = 0.03), and abnormal LV DFG (DFG 1, OR: 5.12 [p = 0.006]; DFG 2, OR: 9.87 [p < 0.001]; and DFG 3, OR: 28.52 [p < 0.001]). Conclusions: LV diastolic dysfunction is a powerful, independent predisposing substrate for the initiation of POAF. Evaluation may be useful during risk stratification of patients undergoing cardiac surgery.