• Kimito Minami, Daijiro Kabata, Takashi Kakuta, Satsuki Fukushima, Tomoyuki Fujita, Ayumi Shintani, Kenji Yoshitani, and Yoshihiko Ohnishi.
• Department of Surgical Intensive Care, National Cerebral and Cardiovascular Center, Osaka, Japan. Electronic address: k.minami@ncvc.go.jp.
• J. Cardiothorac. Vasc. Anesth. 2021 Aug 1; 35 (8): 2392-2396.

ObjectiveThe ability of perioperative fluid management to prevent postoperative recurrence of atrial tachyarrhythmia remains controversial. The aim of the present study was to assess if intraoperative net fluid balance was associated with atrial tachyarrhythmia recurrence after the Cryo-Maze procedure.DesignAn observational cohort study.SettingA tertiary care hospital from April 2007 to May 2019.ParticipantsFour hundred forty-four patients undergoing the Cryo-Maze procedure in conjunction with other cardiac surgeries.InterventionsThe Cryo-Maze procedure in conjunction with other cardiac surgeries.Measurements And Main ResultsThe main outcome was early atrial tachyarrhythmia recurrence, consisting of atrial fibrillation, atrial flutter, or atrial tachycardia, within the first three months after surgery. Complete follow-up was achieved in 443 patients (99.8%), of them 127 (28.6%) developed early atrial tachyarrhythmia recurrence. The median intraoperative net fluid balance was 1,627 mL (interquartile range, -215 to 3,557 mL). Multivariate logistic regression showed that intraoperative net fluid balance (p = 0.001), preoperative AF duration (adjusted odds ratio, 1.40; 95% CI, 1.17-1.68; p < 0.001) and left atrial volume index (aOR, 1.61; 95% CI, 1.06-2.45; p = 0.025) were independent predictors of early atrial tachyarrhythmia recurrence. The adjusted log odds were lowest (-1.52) when net fluid balance was 1,557 mL.ConclusionsThere is a significant U-shaped association between intraoperative net fluid balance and early atrial tachyarrhythmia recurrence among patients undergoing the Cryo-Maze procedure.Copyright © 2020 Elsevier Inc. All rights reserved.

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