Intraoperative hypotension, new onset atrial fibrillation, and adverse outcome after carotid endarterectomy

• Published in: Journal of the neurological sciences Vol. 309; no. 1; pp. 5 - 8
• Main Authors: Sposato, Luciano A, Suárez, Andrés, Jáuregui, Agustín, Riccio, Patricia M, Altounian, Matías, Andreoli, Mauro G, Rodriguez, Andrés I, Ressia, Juan F, Bressan, Gabriela J, Klein, Francisco R, Raffaelli, Héctor, Bozovich, Gerardo E
• Format: Journal Article
• Language: English
• Published: Amsterdam Elsevier B.V 15-10-2011; Elsevier
• Subjects: Aged; Aged, 80 and over; Arrhythmias; Atrial fibrillation; Atrial Fibrillation - diagnosis; Atrial Fibrillation - etiology; Atrial Fibrillation - physiopathology; Biological and medical sciences; Bypass surgery; Carotid artery disease; Carotid artery interventions; Carotid endarterectomy; Cohort Studies; Electrocardiography - methods; Endarterectomy, Carotid - adverse effects; Female; Follow-Up Studies; Humans; Hypotension - diagnosis; Hypotension - etiology; Hypotension - physiopathology; Intraoperative Complications - diagnosis; Intraoperative Complications - etiology; Intraoperative Complications - physiopathology; Male; Medical sciences; Middle Aged; Neurology; Neurosurgery; Outcome; Prognosis; Retrospective Studies; Risk Factors; Risk stratification; Skull, brain, vascular surgery; Stroke; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Treatment Outcome; Carotid artery interventions; Carotid artery disease; Stroke; Carotid endarterectomy; Prognosis; Atrial fibrillation; Outcome; Risk stratification; Bypass surgery; Arrhythmias; Arrhythmia; Cardiovascular disease; Vascular disease; Heart disease; Blood vessel; Endarteriectomy; Cerebrovascular disease; Nervous system diseases; Surgical anastomosis; Intraoperative; Artery; Excitability disorder; Cerebral disorder; Carotid; Central nervous system disease; Risk factor; Circulatory system
• ISSN: 0022-510X; 1878-5883
• DOI: 10.1016/j.jns.2011.07.052

Abstract Background Information regarding predisposing factors, frequency, and prognostic implications of new onset atrial fibrillation (NOAF) after carotid endarterectomy (CEA) is scarce. We assessed the frequency, risk factors, and the prognostic impact of NOAF after CEA. Methods We assessed every patient undergoing CEA (n = 186) at our academic hospital between 2006 and 2009. Patients underwent continuous electrocardiographic monitoring during surgery and during the rest of hospital stay. We performed univariate and multivariate analyses for identifying variables associated with NOAF and for individualizing variables related to four perioperative adverse outcome measures: a) ischemic stroke; b) ischemic stroke and myocardial infarction, c) ischemic stroke and death, and d) ischemic stroke, myocardial infarction, and death. Results The study cohort comprised 186 patients. Overall, NOAF was detected in 7 cases (3.8%). The only variable associated with NOAF was intraoperative hypotension (OR 9.6, 95% CI 1.9–47.4, P = .006). There were no perioperative deaths. NOAF was associated with perioperative ischemic stroke and with the combined outcome of ischemic stroke and myocardial infarction. Conclusions We found a low frequency of NOAF after CEA. Intraoperative hypotension was associated to a higher risk of NOAF. In turn, NOAF was related to adverse postoperative outcome. Further research is needed to clarify the pathophysiological relation between intraoperative hypotension, NOAF, and adverse CEA outcome.