Dilated left atrium as a predictor of late outcome after XXXX concomitant with aortic valve replacement and/or coronary artery bypass grafting

@entity1 @entity712 @entity548 @entity886 @entity358 @entity997 @entity955 @entity453 @entity340 @entity385
OBJECTIVES: Left atrial (LA) dimension can predict @entity955 ( @entity955 ) recurrence after catheter-based or surgical ablation. Pulmonary vein isolation (PVI) may be a surgical option during aortic valve replacement (AVR) and/or coronary artery bypass grafting (CABG), though consensus regarding @entity1 selection and late outcome is lacking. METHODS: We studied 160 @entity1 (mean age 70    9 years) with @entity955 who underwent radiofrequency-based PVI during AVR and/or CABG, and were followed up postoperatively for at least 6 months. Mean preoperative LA dimension was 44    7 mm. Serial echocardiography was performed to evaluate left ventricular (LV) and LA dimensions, E/e', estimated @entity358 (PA) pressure and degree of @entity340 . Follow-up was completed with a mean duration of 47    25 months. RESULTS: At the latest follow-up, 133 @entity1 (83%) remained in sinus rhythm. Preoperative LA dimension was independently associated with increased risk of @entity955 recurrence at 6 months after surgery [adjusted odds ratio 1.3 per 1-mm increase in LA dimension, 95% confidence interval (CI) 1.1-1.6, P < 0.001]. Receiver-operating characteristic curve analysis demonstrated an optimal cut-off value for preoperative LA dimension of 45 mm to predict sinus rhythm restoration (98% for <45 mm vs 55% for >= 45 mm, P < 0.001). @entity1 with LA dimension >= 45 mm had a significantly lower 5-year survival rate (62    7 vs 82    7%, P = 0.025) and freedom from adverse events defined as @entity385 / @entity548 , admission for @entity712 , catheter ablation and permanent pacemaker implantation (58    7 vs 91    4%, P < 0.001). Multivariate analysis showed that preoperative LA dimension >= 45 mm was independently associated with adverse events (adjusted hazards ratio 2.4, 95% CI 1.2-5.1, P = 0.019). Serial echocardiography demonstrated improvement in LV systolic function irrespective of LA dimension, whereas @entity1 with LA dimension >= 45 mm showed less improvement in LA dimension and systolic PA pressure (interaction effect P < 0.001) and persistent higher E/e' (group effect P < 0.001), along with aggravated @entity997 . CONCLUSIONS: In @entity1 with @entity955 related to @entity886 and/or @entity453 , a dilated left atrium (>= 45 mm) was associated with inferior @entity955 - and event-free survival after PVI, accompanied by persistent abnormalities in cardiac and haemodynamic function. These findings may assist @entity1 selection for PVI during AVR and/or CABG.
