Value of Preoperative Echocardiography in the Predic Postoperative Atrial Fibrillation Following Isolated Co Artery Bypass Grafting Tayfun Açıl, MD a, *, Yücel Çölkesen, MD a , Rıza Türköz, MD b , Alpay Turan Sezgin, MD a , Mehmet Baltalı, MD a , Öner Gülcan, MD b , S¸ enol Demircan, MD a , Aylin Yıldırır, MD a , Bülent Özin, MD a , and Haldun Müderrisog˘lu, MD a The value of echocardiography, especially tissue Doppler imaging (TDI), in the assess of risk ofpostoperative atrial fibrillation (AF) aftercoronary artery bypass grafting (CABG) is not clear. One hundred two consecutive patients (80 men; mean age 61 ⴞ 10 years) who underwent elective isolated CABG were included in the study. All patients underwent conventional transthoracic echocardiography and TDI of the left and right heart before surgery. Also,24-hour Holter recordings were obtained for all patients. The study end point was the development of postoperative AF. The surgical mortality rate 2%. Postoperative AF occurred in 18 patients (18%). Patients with postoperative AF h been significantly older than patients without postoperative AF (73 ⴞ 7 vs 58 ⴞ 9 year respectively; p <0.001). Compared with patients without postoperative AF, a significa higher proportion of patients with postoperative AF experienced paroxysmal AF before surgery (6% vs 33%,respectively; p ⴝ 0.001).Patients with postoperative AF had a significantly larger mean left atrial diameter compared with patients without postope AF (37 ⴞ 3 vs 35 ⴞ 3 mm, respectively; p ⴝ 0.012). Multivariate logistic regression anal identified age as the most significant predictor of postoperative AF (odds ratio 1.254, confidence interval 1.127 to 1.396; p <0.001). Of the echocardiographic variables, on atrialdiameter was identified as a significant predictor of postoperative AF (odds ratio 1.250, 95% confidence interval 1.055 to 1.562; p ⴝ 0.047). In conclusion, in the predic of postoperative AF after isolated CABG, preoperative transthoracic echocardiography, including both conventional echocardiography and TDI, is of little value. © 2007 Elsevier Inc.All rights reserved. (Am J Cardiol 2007;100:1383–1386) Postoperative atrial fibrillation (AF) is a common compli- cation after cardiac surgery, associated with high morbidity, prolonged hospitalization, and increased hospital cost. 1 Sev- eral risk factors associated with the development of postop- erative AF have been identified in various studies. However, advanced age was the only factor consistently linked to increased risk of postoperative AF. 1,2 The utility of echo- cardiography, especially tissue Doppler imaging (TDI), in the assessment of risk of postoperative AF after coronary artery bypass grafting (CABG) was evaluated in only a limited number of studies, with conflicting results. 3–7 More- over, most were performed using intraoperative transesoph- ageal echocardiography, which, albeit low, carries a proce- dural risk. In this context, our aim was to evaluate the value of preoperative transthoracic conventional echocardiogra- phy and TDI in assessment of the risk of postoperative AF after isolated CABG. Methods One hundred two consecutive patients who underwent tive isolated CABG (no other concomitant cardiac or ex cardiac procedures) by the same surgeon (RT) at our in tution were included in the study. Exclusion criteria were off-pump technique, urgent or emergency surgery, rhythm other than sinus, dysthyroidism, renal failure requiring he- modialysis, currentuse of antiarrhythmic drugs,repeat CABG, moderate or severe valvular heartdisease, poor echocardiographic image quality, and recent myocardial infarction (⬍1 month). The study protocol was approve the ethics committee of our university (Bas¸kent Unive Ankara, Turkey). All patients gave their informed conse All echocardiographic examinations were performed 2 days before surgery. Images were obtained according to guidelines of the American Society of Echocardiography and stored using a GE/VingMed Vivid 7 digital ultrasou system (GE Vingmed Ultrasound; GE Vingmed Ultraso AS, Horten, Norway). 8,9 On the same day of the echocar- diographic examination, echocardiographic variables were measured offline from digital recordings by an observer who was unaware of results of the study. Leftventricular mass was calculated according to the modified America Society of Echocardiography formula as proposed by D vereux et al. 10 Left ventricular mass was indexed to body Departments of a Cardiology and b Cardiovascular and Thoracic Sur- gery,Bas¸kent University, Ankara, Turkey. Manuscript received April 22, 2007; revised manuscript received and accepted June 5, 2007. *Corresponding author:Tel.: ⫹90-322-327-2727; fax: ⫹90-322- 327-1273. E-mail address: tayfun.acil@gmail.com (T. Açıl). 0002-9149/07/$ – see front matter © 2007 Elsevier Inc. All rights reserved. www.AJConline.org doi:10.1016/j.amjcard.2007.06.025