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Gilbers MD, Kawczynski MJ, Bidar E, Maesen B, Isaacs A, Winters J, Linz D, Rienstra M, van Gelder I, Maessen JG, Schotten U. Clinical Predictors of Device-Detected Atrial Fibrillation During 2.5 Years After Cardiac Surgery: Prospective RACE V Cohort. JACC Clin Electrophysiol 2024; 10:941-955. [PMID: 38483418 DOI: 10.1016/j.jacep.2024.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 01/02/2024] [Accepted: 01/09/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND Postoperative atrial fibrillation (POAF) is a frequent complication after cardiac surgery that is associated with late atrial fibrillation (AF) recurrences (late-POAF) and increased morbidity and long-term mortality. OBJECTIVES This study sought to determine device-detected POAF incidence and to identify clinical variables associated with POAF, both in patients with and without preoperative AF history. METHODS A total of 133 consecutive patients undergoing cardiac surgery were prospectively enrolled and continuously monitored with an implantable loop recorder for 2.5 years after surgery. Preoperative transthoracic echocardiography, 12-lead electrocardiogram, blood biomarkers, and clinical data were analyzed to develop prediction models for early- and late-POAF. RESULTS In patients without preoperative AF history, early-POAF within the first 90 postoperative days occurred in 41 (47.1%) of 87 patients. Late-POAF after the first 90 postoperative days occurred in 22 (25%) of 87 patients, and 20 of these patients also had early-POAF during the first 90 days (20 of 22 [91%]). Increased right atrial minimum volume indexed for body surface area (RAVImin) and early-POAF were independently associated with late-POAF. A prediction model for late-POAF, which included RAVImin >11 mL/m2, age >65 years, and early-POAF, achieved an area under the curve of 0.82 (95% CI: 0.72-0.92). For patients with preoperative AF-history, late-POAF recurrences were frequent (22 of 33 [67%]). Increased RAVImin was independently associated with a higher incidence of late-POAF. CONCLUSIONS In patients with and without AF history, late-POAF recurrences are frequent, including in patients undergoing surgical AF ablation. In patients with no history of AF, late-POAF might be predicted with excellent accuracy by using a combination of preoperative variables. In patients with a history of AF, signs of advanced AF substrate (eg, increased right atrial volumes) were associated with long-term AF recurrences. [Reappraisal of Atrial Fibrillation: Interaction Between Hypercoagulability, Electrical Remodeling, and Vascular Destabilisation in the Progression of AF; NCT03124576].
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Affiliation(s)
- Martijn D Gilbers
- Department of Cardiothoracic Surgery, Heart & Vascular Centre, Maastricht University Medical Centre, Maastricht, the Netherlands; Department of Physiology, Maastricht University, Maastricht, the Netherlands
| | - Michal J Kawczynski
- Department of Cardiothoracic Surgery, Heart & Vascular Centre, Maastricht University Medical Centre, Maastricht, the Netherlands; Department of Physiology, Maastricht University, Maastricht, the Netherlands
| | - Elham Bidar
- Department of Cardiothoracic Surgery, Heart & Vascular Centre, Maastricht University Medical Centre, Maastricht, the Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands
| | - Bart Maesen
- Department of Cardiothoracic Surgery, Heart & Vascular Centre, Maastricht University Medical Centre, Maastricht, the Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands
| | - Aaron Isaacs
- Department of Physiology, Maastricht University, Maastricht, the Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands
| | - Joris Winters
- Department of Physiology, Maastricht University, Maastricht, the Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands
| | - Dominik Linz
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands; Department of Cardiology, Heart & Vascular Centre, Maastricht University Medical Centre, Maastricht, the Netherlands; Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Michiel Rienstra
- Department of Cardiology, University Medical Centre Groningen, Groningen, the Netherlands
| | - Isabelle van Gelder
- Department of Cardiology, University Medical Centre Groningen, Groningen, the Netherlands
| | - Jos G Maessen
- Department of Cardiothoracic Surgery, Heart & Vascular Centre, Maastricht University Medical Centre, Maastricht, the Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands
| | - Ulrich Schotten
- Department of Physiology, Maastricht University, Maastricht, the Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands; Department of Cardiology, Heart & Vascular Centre, Maastricht University Medical Centre, Maastricht, the Netherlands.
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Niu J, Zhang M, Liu P, Hua C, Zhong G. Research progress on predicting atrial fibrillation recurrence after radiofrequency ablation based on electrocardiogram-related parameters. J Electrocardiol 2023; 81:146-152. [PMID: 37708737 DOI: 10.1016/j.jelectrocard.2023.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 08/18/2023] [Accepted: 08/28/2023] [Indexed: 09/16/2023]
Abstract
Atrial fibrillation (AF) is the most common arrhythmia. It is associated with increased stroke risks, thromboembolism, and other complications, which are great life and economic burdens for patients. In recent years, with the maturity of percutaneous catheter radiofrequency ablation (RFA) technology, it has become a first-line therapy for AF. However, some patients still experience AF recurrence (AFR) after RFA, which can cause serious consequences. Therefore, it is critical to identify appropriate parameters that are predictive of prognosis and to be able to translate the parameters easily into the clinical setting. Here, we reviewed possible predicting indicators for AFR, focusing on all the electrocardiogram indicators, such as P wave duration, PR interval and so on. It may provide valuable information for guiding clinical works.
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Affiliation(s)
- Jiayin Niu
- Heart Center, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Min Zhang
- Research Ward, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Pengfei Liu
- Heart Center, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Cuncun Hua
- Heart Center, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Guangzhen Zhong
- Heart Center, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China; Research Ward, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.
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Wynne R, Ferguson C. Predicting atrial fibrillation after cardiac surgery. Perfusion 2023; 38:657-658. [PMID: 34961380 DOI: 10.1177/02676591211064958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Rochelle Wynne
- Western Sydney Nursing & Midwifery Research Centre, Blacktown Clinical & Research School, 1760Western Sydney University & Western Sydney Local Health District, New South Wales, Australia.,School of Nursing & Midwifery, 2104Deakin University, Victoria, Australia
| | - Caleb Ferguson
- Western Sydney Nursing & Midwifery Research Centre, Blacktown Clinical & Research School, 1760Western Sydney University & Western Sydney Local Health District, New South Wales, Australia
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Fields KG, Ma J, Petrinic T, Alhassan H, Eze A, Reddy A, Hedayat M, Providencia R, Lip GYH, Bedford JP, Clifton DA, Redfern OC, O'Brien B, Watkinson PJ, Collins GS, Muehlschlegel JD. Multivariable prediction models for atrial fibrillation after cardiac surgery: a systematic review protocol. BMJ Open 2023; 13:e067260. [PMID: 36914189 PMCID: PMC10016290 DOI: 10.1136/bmjopen-2022-067260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/14/2023] Open
Abstract
INTRODUCTION Dozens of multivariable prediction models for atrial fibrillation after cardiac surgery (AFACS) have been published, but none have been incorporated into regular clinical practice. One of the reasons for this lack of adoption is poor model performance due to methodological weaknesses in model development. In addition, there has been little external validation of these existing models to evaluate their reproducibility and transportability. The aim of this systematic review is to critically appraise the methodology and risk of bias of papers presenting the development and/or validation of models for AFACS. METHODS We will identify studies that present the development and/or validation of a multivariable prediction model for AFACS through searches of PubMed, Embase and Web of Science from inception to 31 December 2021. Pairs of reviewers will independently extract model performance measures, assess methodological quality and assess risk of bias of included studies using extraction forms adapted from a combination of the Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies checklist and the Prediction Model Risk of Bias Assessment Tool. Extracted information will be reported by narrative synthesis and descriptive statistics. ETHICS AND DISSEMINATION This systemic review will only include published aggregate data, so no protected health information will be used. Study findings will be disseminated through peer-reviewed publications and scientific conference presentations. Further, this review will identify weaknesses in past AFACS prediction model development and validation methodology so that subsequent studies can improve upon prior practices and produce a clinically useful risk estimation tool. PROSPERO REGISTRATION NUMBER CRD42019127329.
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Affiliation(s)
- Kara G Fields
- Department of Anesthesiology, Perioperative and Pain Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Jie Ma
- Centre for Statistics in Medicine, Nuffield Department of Orthopedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Tatjana Petrinic
- Bodleian Health Care Libraries, University of Oxford, Oxford, UK
| | - Hassan Alhassan
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Anthony Eze
- Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Ankith Reddy
- University of Texas Medical Branch, School of Medicine, Galveston, Texas, USA
| | - Mona Hedayat
- Department of Anesthesiology, Perioperative and Pain Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Rui Providencia
- Institute of Health Informatics Research, University College London, London, UK
- Department of Cardiac Electrophysiology, Barts Heart Centre, St. Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, UK
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Jonathan P Bedford
- Kadoorie Centre for Critical Care Research and Education, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - David A Clifton
- Department of Engineering Science, University of Oxford, Oxford, UK
| | - Oliver C Redfern
- Kadoorie Centre for Critical Care Research and Education, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Benjamin O'Brien
- Department of Cardiac Anesthesiology and Intensive Care Medicine, Deutsches Herzzentrum Berlin, Charité Universitätsmedizin Berlin, Berlin, Germany
- Department of Perioperative Medicine, St. Bartholomew's Hospital and Barts Heart Centre, Barts Health NHS Trust, London, UK
- Outcomes Research Consortium, Cleveland, Ohio, USA
| | - Peter J Watkinson
- Kadoorie Centre for Critical Care Research and Education, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- Oxford University Hospitals NHS Trust, Oxford, UK
- NIHR Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Gary S Collins
- Centre for Statistics in Medicine, Nuffield Department of Orthopedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Jochen D Muehlschlegel
- Department of Anesthesiology, Perioperative and Pain Medicine, Harvard Medical School, Boston, Massachusetts, USA
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Raman J, Venkatesh S, Bellomo R. Machine Learning in Risk Prediction for Cardiac Surgery - An Emerging Trend? Heart Lung Circ 2021; 30:1790-1791. [PMID: 34598888 DOI: 10.1016/j.hlc.2021.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Jaishankar Raman
- Austin & St Vincent's Hospitals, Melbourne, University of Melbourne, Melbourne, Vic, Australia; Deakin University, Geelong & Melbourne, Vic, Australia; University of Illinois at Urbana-Champaign, Champaign, IL, US.
| | - Svetha Venkatesh
- Applied Artificial Intelligence Institute, Deakin University, Geelong, Vic, Australia
| | - Rinaldo Bellomo
- Intensive Care Research, University of Melbourne, Melbourne, Monash University, Melbourne, Vic, Australia
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