• Deepak Prakash Borde, Shreedhar Joshi, Ashish Agrawal, Deepak Bhavsar, Pooja Joshi, and Pramod Apsingkar.
• Department of Cardiac Anesthesia, Ozone Anesthesia Group, Aurangabad, Maharashtra, India. Electronic address: deepakborde2482@gmail.com.
• J. Cardiothorac. Vasc. Anesth. 2024 Nov 1; 38 (11): 258225912582-2591.

ObjectivePostoperative atrial fibrillation (POAF) is associated with increased morbidity, mortality, and length of hospital stay. The objective of this study was to assess the utility of left atrial strain (LAS) to predict POAF in patients undergoing off-pump coronary artery bypass grafting (OPCABG).DesignRetrospective observational study.SettingTertiary care hospital.Participants103 patients undergoing OPCABG.InterventionsNone.Measurements And ResultsIn addition to comprehensive transthoracic echocardiography, LAS was measured for reservoir (R), conduction (CD), and contraction (CT) components. POAF was defined as new electrocardiographic evidence of AF requiring treatment. Logistic regression was done to assess factors associated with POAF. The diagnostic accuracy of variables in predicting POAF was assessed by receiver operating characteristic analysis. POAF was documented in 24 (23.3%) patients. There was no difference in ejection fraction, average global longitudinal strain, or proportion of left ventricular diastolic dysfunction grades between patients with POAF and patients without POAF. All three components of LAS: LAS R (19.2 ± 4.7 v 23.5 ± 4.8, p < 0.001), LAS CD (8.9 ± 3.7 v 12.3 ± 4.8, p = 0.1), and LAS CT (10.3 ± 3.9 v 12.1 ± 4.1, p = 0.04), were significantly lower among patients with POAF compared with patients without POAF, respectively. According to univariate analysis, all components of LAS were statistically significant predictors of POAF. In multivariate analysis, only age (odds ratio = 1.08, p = 0.025) and LAS R (odds ratio = 0.84, p = 0.004) were independently associated with POAF. LAS R was a better predictor of POAF, with an area under the curve (AUC) of 0.758, than LAS CD (AUC = 0.67) and LAS CT (AUC = 0.62). LAS R had an optimal cutoff of 23% with sensitivity of 95.8% (confidence interval: 78.9-99.9%) and specificity of 49.4% (37.9-60.9%) to predict POAF.ConclusionsLAS R is a significant predictor of POAF, and its use can be recommended for screening of OPCABG patients at high risk of POAF.Copyright © 2024 Elsevier Inc. All rights reserved.

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