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Prognostic factors of atrial fibrillation following coronary artery bypass graft surgery

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Abstract

Objective

Postoperative atrial fibrillation (POAF) is the most common complication after cardiac surgery. To prevent this complication, routine pharmacological prophylactic drugs could be administered. Our study aimed to analyze the various perioperative factors associated with the development of POAF after coronary artery bypass graft (CABG) surgery.

Methods

This prospective study included 617 patients, who received CABG surgery in the year 2014.

Results

There were 429 (69.5%) male and 188 (30.5%) female patients. Mean patient age was 67.2 (9.4) years, and 365 patients (59.2%) were more than 65 years. Incidence of POAF was 24.1% (N = 149). Multivariable analysis showed that independent predictors of POAF after CABG surgery were: age >65 (P  = 0.008; OR 2.089; 95% CI 1.208–3.613), AF in the past (P < 0.001; OR 10.838; 95% CI 5.28–22.247), preoperative hypertrophy or dilation of left atrium (P = 0.002; OR 4.996; 95% CI 1.823–13.691), CABG surgery using 4 or more bypass grafts (P = 0.042; OR 1.669; 95% CI 0.972–2.866), preoperative hypokalemia (P = 0.001; OR 3.317; 95% CI 1.678–6.559), >trivial mitral (P = 0.024; OR 7.556; 95% CI 0.964–20.376), and aortic (P = 0.009; OR 1.937; 95% CI 1.178–3.187) valve regurgitation.

Conclusions

The profile of patients affected by POAF was considerably different with regard to the demographics, preoperative heart condition, history of previous heart rhythm disorders, and operative data. The most important independent factors that predicted POAF after CABG surgery were associated with structural heart defects, advanced age, history of previous AF, and preoperative hypokalemia.

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References

  1. Zaman AG, Archbold RA, Helft G, Paul EA, Curzen NP, Mills PG. Atrial fibrillation after coronary artery bypass surgery: a model for preoperative risk stratification. Circulation. 2000;101(12):1403–8.

    Article  CAS  PubMed  Google Scholar 

  2. Mathew JP, Fontes ML, Tudor IC, Ramsay J, Duke P, Mazer CD, et al. A multicenter risk index for atrial fibrillation after cardiac surgery. JAMA. 2004;291(14):1720–9.

    Article  CAS  PubMed  Google Scholar 

  3. Aranki SF, Shaw DP, Adams DH, Rizzo RJ, Couper GS, VanderVliet M, et al. Predictors of atrial fibrillation after coronary artery surgery. Current trends and impact on hospital resources. Circulation. 1996;94(3):390–7.

    Article  CAS  PubMed  Google Scholar 

  4. Mariscalco G, Biancari F, Zanobini M, Cottini M, Piffaretti G, Saccocci M, et al. Bedside tool for predicting the risk of postoperative atrial fibrillation after cardiac surgery: the POAF score. J Am Heart Assoc. 2014;3(2):e000752.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Shen J, Lall S, Zheng V, Buckley P, Damiano RJ, Schuessler RB. The persistent problem of new-onset postoperative atrial fibrillation: a single-institution experience over two decades. J Thorac Cardiovasc Surg. 2011;141(2):559–70.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Villareal RP, Hariharan R, Liu BC, Kar B, Lee VV, Elayda M, et al. Postoperative atrial fibrillation and mortality after coronary artery bypass surgery. J Am Coll Cardiol. 2004;43(5):742–8.

    Article  PubMed  Google Scholar 

  7. Mariscalco G, Klersy C, Zanobini M, Banach M, Ferrarese S, Borsani P, et al. Atrial fibrillation after isolated coronary surgery affects late survival. Circulation. 2008;118(16):1612–8.

    Article  PubMed  Google Scholar 

  8. Mahoney EM, Thompson TD, Veledar E, Williams J, Weintraub WS. Cost-effectiveness of targeting patients undergoing cardiac surgery for therapy with intravenous amiodarone to prevent atrial fibrillation. J Am Coll Cardiol. 2002;40(4):737–45.

    Article  PubMed  Google Scholar 

  9. Mariscalco G, Engstrom KG. Atrial fibrillation after cardiac surgery: risk factors and their temporal relationship in prophylactic drug strategy decision. Int J Cardiol. 2008;129(3):354–62.

    Article  PubMed  Google Scholar 

  10. Barbieri LR, Sobral MLP, Gerônimo GMDS, dos Santos GG, Sbaraíni E, Dorfman FK, et al. Incidence of stroke and acute renal failure in patients of postoperative atrial fibrillation after myocardial revascularization. Rev Bras Cir Cardiovasc. 2013;28(4):442–8.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Haghjoo M, Basiri H, Salek M, Sadr-Ameli MA, Kargar F, Raissi K, et al. Predictors of postoperative atrial fibrillation after coronary artery bypass graft surgery. Indian Pacing Electrophysiol J. 2008;8(2):94–101.

    PubMed  PubMed Central  Google Scholar 

  12. Hakala T, Pitkänen O, Hippeläinen M. Feasibility of predicting the risk of atrial fibrillation after coronary artery bypass surgery with logistic regression model. Scand J Surg. 2002;91(4):339–44.

    Article  CAS  PubMed  Google Scholar 

  13. Lahtinen J, Biancari F, Salmela E, Mosorin M, Satta J, Rainio P, et al. Postoperative atrial fibrillation is a major cause of stroke after on-pump coronary artery bypass surgery. Ann Thorac Surg. 2004;77(4):1241–4.

    Article  PubMed  Google Scholar 

  14. Ferro CRC, de Oliveira DC, Nunes FP, Piegas LS. Postoperative atrial fibrillation after cardiac surgery. Arq Bras Cardiol. 2009;93(1):59–63.

    Article  PubMed  Google Scholar 

  15. Pivatto Junior F, Teixeira Filho GF, Michelin St’anna JR, Py PM, Prates PR, Nesralla IAA, et al. Advanced age and incidence of atrial fibrillation in the postoperative period of aortic valve replacement. Rev Bras Cir Cardiovasc. 2014;29(1):45–50.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Zoghbi WA, Enriquez-Sarano M, Foster E, Grayburn PA, Kraft CD, Levine RA, et al. Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and doppler echocardiography. J Am Soc Echocardiogr. 2003;16(7):777–802.

    Article  PubMed  Google Scholar 

  17. Ascione R, Caputo M, Calori G, Lloyd CT, Underwood MJ, Angelini GD. Predictors of atrial fibrillation after conventional and beating heart coronary surgery: a prospective, randomized study. Circulation. 2000;102(13):1530–5.

    Article  CAS  PubMed  Google Scholar 

  18. Osranek M, Fatema K, Qaddoura F, Al-Saileek A, Barnes ME, Bailey KR, et al. Left atrial volume predicts the risk of atrial fibrillation after cardiac surgery. A prospective study. J Am Coll Cardiol. 2006;48(4):779–86.

    Article  PubMed  Google Scholar 

  19. Abhayaratna WP, Seward JB, Appleton CP, Douglas PS, Oh JK, Tajik AJ, et al. Left atrial size. J Am Coll Cardiol. 2006;47(12):2357–63.

    Article  PubMed  Google Scholar 

  20. Echahidi N, Pibarot P, O’Hara G, Mathieu P. Mechanisms, prevention, and treatment of atrial fibrillation after cardiac surgery. J Am Coll Cardiol. 2008;51:793–801.

    Article  CAS  PubMed  Google Scholar 

  21. Pfisterer ME, Klöter-Weber UCD, Huber M, Osswald S, Buser PT, Skarvan K, et al. Prevention of supraventricular tachyarrhythmias after open heart operation by low-dose sotalol: a prospective, double-blind, randomized, placebo-controlled study. Ann Thorac Surg. 1997;64(4):1113–9.

    Article  CAS  PubMed  Google Scholar 

  22. Thoren E, Hellgren L, Jideus L, Stahle E. Prediction of postoperative atrial fibrillation in a large coronary artery bypass grafting cohort. Interact Cardiovasc Thorac Surg. 2012;14(5):588–93.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Amar D, Shi W, Hogue CW, Zhang H, Passman RS, Thomas B, et al. Clinical prediction rule for atrial fibrillation after coronary artery bypass grafting. J Am Coll Cardiol. 2004;44(6):1248–53.

    Article  PubMed  Google Scholar 

  24. Allessie MA, Boyden PA, Camm AJ, Kleber AG, Lab MJ, Legato MJ, et al. Pathophysiology and prevention of atrial fibrillation. Circulation. 2001;103(5):769–77.

    Article  CAS  PubMed  Google Scholar 

  25. Rostagno C, La Meir M, Gelsomino S, Ghilli L, Rossi A, Carone E, et al. Atrial fibrillation after cardiac surgery: incidence, risk factors, and economic burden. J Cardiothorac Vasc Anesth. 2010;24(6):952–8.

    Article  PubMed  Google Scholar 

  26. Wahr JA, Parks R, Boisvert D, Comunale M, Fabian J, Ramsay J, et al. Preoperative serum potassium levels and perioperative outcomes in cardiac surgery patients. Multicenter Study of Perioperative Ischemia Research Group. JAMA. 1999;281(23):2203–10.

    Article  CAS  PubMed  Google Scholar 

  27. Hashemzadeh K, Dehdilani M, Dehdilani M. Postoperative atrial fibrillation following open cardiac surgery: predisposing factors and complications. J Cardiovasc Thorac Res. 2007;2013(5):101–7.

    Google Scholar 

  28. Ali IM, Sanalla AA, Clark V. Beta-blocker effects on postoperative atrial fibrillation. Eur J Cardio-thoracic Surg. 1997;11(6):1154–7.

    Article  CAS  Google Scholar 

  29. White HD, Antman EM, Glynn MA, Collins JJ, Cohn LH, Shemin RJ, et al. Efficacy and safety of timolol for prevention of supraventricular tachyarrhythmias after coronary artery bypass surgery. Circulation. 1984;70(3):479–84.

    Article  CAS  PubMed  Google Scholar 

  30. Crystal E. Interventions on prevention of postoperative atrial fibrillation in patients undergoing heart surgery: a meta-analysis. Circulation. 2002;106(1):75–80.

    Article  PubMed  Google Scholar 

  31. Kalman JM, Munawar M, Howes LG, Louis WJ, Buxton BF, Gutteridge G, et al. Atrial fibrillation after coronary artery bypass grafting is associated with sympathetic activation. Ann Thorac Surg. 1995;60(6):1709–15.

    Article  CAS  PubMed  Google Scholar 

  32. Jidéus L, Blomström P, Nilsson L, Stridsberg M, Hansell P, Blomström-Lundqvist C. Tachyarrhythmias and triggering factors for atrial fibrillation after coronary artery bypass operations. Ann Thorac Surg. 2000;69(4):1064–9.

    Article  PubMed  Google Scholar 

  33. Sezai A, Nakata K-I, Iida M, Yoshitake I, Wakui S, Osaka S, et al. A study on the occurrence and prevention of perioperative stroke after coronary artery bypass grafting. Ann Thorac Cardiovasc Surg. 2015;21(3):275–81.

    Article  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Medical Academy, Lithuanian University of Health Sciences, Kaunas, 2 Eiveniu St, 50009, Kaunas, Lithuania

    Mantas Kievišas, Egidijus Vaitiekūnas & Lukas Dambrauskas

  2. Department of Cardiothoracic and Vascular Surgery, Medical Academy, Lithuanian University of Health Sciences, Kaunas, 2 Eiveniu St, 50009, Kaunas, Lithuania

    Vytenis Keturakis & Šarūnas Kinduris

  3. Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, 2 Eiveniu St, 50009, Kaunas, Lithuania

    Loreta Jankauskienė

  4. Institute of Cardiology, Lithuanian University of Health Sciences, Kaunas, 2 Eiveniu St, 50009, Kaunas, Lithuania

    Šarūnas Kinduris

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  1. Mantas Kievišas
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Correspondence to Mantas Kievišas.

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Kievišas, M., Keturakis, V., Vaitiekūnas, E. et al. Prognostic factors of atrial fibrillation following coronary artery bypass graft surgery. Gen Thorac Cardiovasc Surg 65, 566–574 (2017). https://doi.org/10.1007/s11748-017-0797-6

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  • DOI: https://doi.org/10.1007/s11748-017-0797-6

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