Prediction of postoperative atrial fibrillation with left atrial mechanical functions and NT-pro ANP levels after coronary artery bypass surgery: A three-dimensional echocardiography study

Echocardiography. 2018 May;35(5):661-666. doi: 10.1111/echo.13833. Epub 2018 Feb 19.


Objective: Postoperative AF (POAF) is the most common cause of morbidity after coronary artery bypass surgery. In this study, we aimed to show the relationship between POAF and N-terminal pro-atrial natriuretic peptide (NT-pro ANP) levels and the relationship between mechanical functions and left atrial volume measured using preoperative three-dimensional echocardiography (3D ECHO) among patients that will undergo isolated coronary artery bypass grafting (CABG) in elective conditions.

Method: Sixty-six consecutive patients (51 male, 15 female) who were decided to undergo CABG and had normal sinus rhythm were involved in the study. Patients were followed by continuous electrocardiography monitoring and daily electrocardiogram. LA volume and mechanical functions were calculated with 3D ECHO. In addition, for the analysis of plasma levels of NT-pro ANP, blood samples were collected before the surgery.

Results: During follow-up after the operation, 15 patients (22.7%) had postoperative atrial fibrillation. LA Vmax, Vmin, VpreA values were higher (P < .001, P = .004, P < .001 respectively) Also in POAF-developed group and SR group, LAVI values were 27.56 ± 4.2 and 20.7 ± 4.64 mL/m2 , respectively (P < .001). In POAF-developing group, NT-pro ANP levels were significantly higher (P < .001). In multiple logistic regression analysis, age (β = 0.355, P = .007) and LAVI (β = 0.668, P = .012) are independent predictors of POAF.

Conclusion: It was found that 3D echocardiography can be used as a helping noninvasive method to show subclinical atrial volume and mechanical dysfunction in patients undergoing CABG. Also, blood levels of NT-pro ANP in POAF group were increased.

Keywords: atrial fibrillation; coronary artery bypass surgery; left atrial volume; three-dimensional echocardiography.

MeSH terms

  • Aged
  • Atrial Fibrillation / blood
  • Atrial Fibrillation / diagnosis*
  • Atrial Fibrillation / etiology
  • Atrial Function, Left / physiology*
  • Atrial Natriuretic Factor / blood*
  • Biomarkers / blood
  • Coronary Artery Bypass / adverse effects*
  • Coronary Artery Disease / surgery
  • Echocardiography, Three-Dimensional*
  • Female
  • Follow-Up Studies
  • Heart Atria / diagnostic imaging*
  • Heart Atria / physiopathology
  • Humans
  • Male
  • Middle Aged
  • Postoperative Complications*
  • Predictive Value of Tests
  • Protein Precursors / blood*
  • Retrospective Studies


  • Biomarkers
  • N-terminal proatrial natriuretic peptide
  • Protein Precursors
  • Atrial Natriuretic Factor