Arrhythmias & electrophysiology
Postoperative pericardial effusion, pericardiotomy, and atrial fibrillation: An explanatory analysis of the PALACS trial
Authors' conclusion
Reduction in postero-lateral pericardial effusion is a plausible mechanism for the effect of posterior pericardiotomy in reducing POAF.
Study context
- Population
- PALACS patients undergoing cardiac surgery with available echocardiographic data387/420, 92% with echo data
- Participants
- 387 patients
- Comparison
- Posterior pericardiotomy vs no pericardiotomy
- Primary endpoint
- Association of POAF reduction with postoperative pericardial effusion and/or left atrial size and function
Methodological detailsexplanatory analysis, Spline and multivariable logistic regression analyses
- Explanatory analysis
- Spline and multivariable logistic regression analyses
Primary result
As reported in the abstract
Postero-lateral pericardial effusion
P < 0.001
- Postero-lateral effusion ≥10 mm associated with postoperative atrial fibrillation (POAF) (non-linear, cut-off 10 mm)
- OR 2.70; 95% CI 1.13, 6.47; P = .03
- Confirmed in multivariable analysis
- OR 3.5, 95% CI 1.17, 10.58; P = 0.02
Further findings
Postoperative pericardial effusion (any)
- Any effusion
- n = 307, 79%
- Anterior
- 68%
- Postero-lateral
- 51.9%
Effusion size, POAF vs no POAF
- Anterior effusion median: 5.0 [IQR 3.0-7.0] vs 5.0 [IQR 3.0-7.5] mm
- P = 0.42
- Postero-lateral effusion median, nonsignificant trend: 5.0 [IQR 3.0-9.0] vs 4.0 [IQR 3.0-6.4] mm
- P = 0.06
Original publication
Postoperative pericardial effusion, pericardiotomy, and atrial fibrillation: An explanatory analysis of the PALACS trial. Am Heart J. Published 18 March 2023. doi:10.
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