High-Burden Premature Atrial Contractions Predict New-Onset Atrial Fibrillation After Surgical Septal Myectomy

https://doi.org/10.1016/j.amjcard.2023.03.033Get rights and content

Although increased premature atrial contractions (PACs) reportedly predict atrial fibrillation (AF) in both general and specific (e.g., patients with stroke) populations, early postoperative AF (POAF) risk in patients with increased PAC burden who require cardiac surgery remains unclear. We examined the correlation between different preoperative PAC burdens and POAF in patients with obstructive hypertrophic cardiomyopathy (OHCM) who underwent surgical treatment. We analyzed 304 consecutively admitted patients with OHCM without previous AF who underwent isolated septal myectomy between January 2015 and December 2018. All patients underwent preoperative 24-hour Holter electrocardiogram monitoring. PACs were present in 259 patients (85.20%) and absent in 45 patients (14.80%). According to the cut-off PAC number of 100 beats/24 hours, there were 211 patients (69.41%) with low-burden PACs and 48 patients (15.79%) with high-burden PACs. AF after septal myectomy occurred in 73 patients, which consisted of 3/45 in the non-PAC group (6.67%), 47/211 in the low-PAC-burden group (22.27%), and 23/48 in the high PAC burden group (47.92%). POAF incidence was higher in both low- and high-burden patients than in patients without PAC (p <0.01). Multivariate logistic regression analyses demonstrated that high-burden PACs (p = 0.02) and age (p <0.01) but not low-burden PACs (p = 0.22) independently predicted POAF in patients with OHCM. The area under the receiver operating characteristic curve for preoperative PACs was 0.72 (95% confidence interval 0.66 to 0.79, p <0.01, sensitivity: 68.49%, specificity: 69.26%). In conclusion, POAF incidence was significantly higher in patients with preoperative high-burden PACs and can predict POAF in patients with OHCM.

Section snippets

Methods

From January 2015 to December 2018, a total of 695 patients with OHCM consecutively admitted at our institution underwent septal myectomy. We excluded 55 patients with preoperative AF history, 291 patients with other cardiac surgeries, 29 patients without a 24-hour Holter electrocardiogram, 16 patients with preoperative permanent pacemaker installation and ventricular septal ablation, and 304 consecutively admitted patients who underwent isolated septal myectomy (Figure 1). According to the

Results

Data on baseline characteristics of the entire population classified by PAC numbers are listed in Table 1. All patients recovered well during the perioperative period without major complications. A total of 304 consecutively admitted patients with OHCM (183 men, 60.20%; median age: 47 years) were included in the study. Of these, 45 patients (14.80%) had no PACs and 259 patients (85.20%) had PACs. Patients were divided into low-PAC-burden (n = 211, 69.41%) and high PAC burden (n = 48, 15.79%)

Discussion

There are relatively few studies on the relation between PACs in preoperative 24-hour Holter monitoring and POAF after cardiac surgery, particularly in patients with OHCM with left ventricular diastolic insufficiency. In this study, we investigated the correlation between preoperative PACs with different burdens and POAF in patients with OHCM who underwent isolated septal myectomy. The main findings of this study were as follows: first, PAC incidence was high (85%) in patients with OHCM without

Disclosures

The authors have no conflicts of interest to declare.

Acknowledgment

The authors would like to thank Editage (http://www.editage.cn) for English language editing.

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    Drs. Meng and Nie contributed equally to this work and share first authorship.

    Funding: This work was supported by the Chinese National High Level Hospital Clinical Research Funding, 2022-GSP-GG-29 and Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences, Beijing, China, 2022-I2M-1-005.

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