Predictors of atrial fibrillation following coronary artery bypass surgery
- postoperative atrial fibrillation,
- cardiac surgery,
How to Cite
Atrial fibrillation (AF) is the most common type of arrhythmia following open heart surgery and it contributes to prolonged hospital stay, increased prevalence of thromboembolic complications and overall increased postoperative morbidity and mortality. The aim of this prospective observational follow-up study was to determine the incidence of postoperative atrial fibrillation (POAF) in patients undergoing coronary artery bypass surgery, to identify predisposing risk factors for its occurrence in the immediate preoperative period and to assess its effect on the postoperative outcome in patients at the University Clinic for Cardiac Surgery in Skopje, North Macedonia. Material and methods: The study included patients at the University Clinic for Cardiac Surgery in Skopje, North Macedonia undergoing coronary artery bypass surgery. The experimental group included patients developing POAF, whereas the control group those who did not develop the primary outcome. All patients were followed up for a period of 30 days postoperatively. Results: POAF was registered in 38% of the patient population and more frequently in the elderly. Patients developing POAF had significantly higher left atrial volume index, as well as higher CHADS2-VASC2, HATCH and Euroscore I values. Average time to POAF occurrence was 48-72 hours postoperatively. There were death outcomes, thromboembolic events, longer hospital stay, need for antiarrhythmic and oral anticoagulant therapy in the POAF group. Conclusion: POAF significantly increases postoperative morbidity and mortality in patients undergoing coronary artery bypass surgery. Age, higher CHADS2-VASC2, HATCH and Euroscore I values and left atrial volume were found to be significant predictors of POAF after coronary artery bypass surgery.
- Maisel WH, Rawn JD, Stevenson WG. Atrial fibrillation after cardiacsurgery. Ann Intern Med 2001; 135: 1061 – 1073.
- 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(8): 793–801
- Yadava M, Hughey AB, Crawford TC. Postoperative atrial fibrillation: incidence,
- mechanisms, and clinical correlates. Cardiol Clin 2014;32(4): 627-36.
- Aranki SF, Shaw DP, Adams DH, Rizzo RJ, Couper GS, VanderVliet Met al. Predictors of atrial fibrillation after coronary artery surgery. Circulation 1996; 94:390–7.
- 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;291:1720–9.
- Lang RM, Badano PB, Mor-Avi V, Afilalo J et al. Recommendations for cardiac
- chamber quantification by echocardiography in adults. An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 2015; 16: 233–71.
- Amar D, Zhang H, Leung D, Alan H, Kadish A. Older аge is the strongest
- predictor of postoperative аtrial фibrillation. Anesthesiology 2002;96:352–6
- Babaev AA, Vloka ME, Sadurski R, Steinberg JS. Influence of age on atrial
- activation as measured by the P-wave signal-averaged electrocardiogram.
- Am J Cardiol 2000;86:692–5
- Leitch JW, Thomson D, Baird DK, Harris PJ. The importance of age as a predictor of atrial fibrillation and flutter after coronary artery bypass grafting. J Thorac Cardiovasc Surg 1990;100:338-342
- Crosby LH, Pifalo WB, Woll KR, Burkholder JA. Risk factors for atrial fibrillation after coronary artery bypass grafting. Am J Cardiol 1990;66:1520-1522.
- 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;94:390-7.
- Pollock BD, Filardo G, da Graca B, Phan TK, Ailawadi G, Thourani V et al. Predicting new-onset post-coronary artery bypass graft atrial fibrillation with existing risk scores. Ann Thorac Surg 2018;105(1):115-21.
- 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;48:779–86.
- Fuller MS, Eagle KA, Buckley MJ, DeSanctis RW. Atrial fibrillation following coronary arterybypass surgery. Prog Cardiovasc Diss 1989;31(5):367-378
- Hashimoto K, llstrup DM, Schaff HV. Influence of clinical and hemodynamic variables on risk of supraventricular tachycardia after coronary artery bypass. J Thorac Cardiovasc Surg 1991;101:56-65
- Caretta Q, Mercanti CA, DeNardo D, Chiarotti F, Scibilia G, Reale A et al. Ventricularconduction defects and atrial fibrillation after coronary artery bypass grafting, multivariate analysis of preoperative, intraoperative and postoperative variables. Eur J Cardiol 199I;12:1107-1111.
- Kalman JM. Munawar m, Howes LG, Louis WJ, Buxton BF, Gutteridge G et al Atrialfibrillation after coronary artery bypass grafting is associated with sympathetic activation. Ann Thorac Surg 1995;60:1709-1715.
- Creswell LL, Schuessler RB, Rosenbloom M, Cox JL. Hazards of postoperative atrial arrhythmias. Ann Thorac Surg 1993;56:539-49.
- Mathew JP, Fontes ML, Tudor IC, Ramsay J, Duke P, Mazer CD et al. Multicenter study of perioperative ischemia research group: A multicenter risk index for atrial fibrillation after cardiac surgery. JAMA 2004, 291:1720-9.
- Maisel WH, Rawn JD, Stevenson WG: Atrial fibrillation after cardiac surgery. Ann Intern Med 2001, 135:1061-73.
- Chua, Su-Kiat et al.Clinical utility of CHADS2 and CHA2DS2-VASc scoring systems for predicting postoperative atrial fibrillation after cardiac surgery. J Thorac Cardiovasc Surg 2013;146(4); 919 – 26.
- De Vos CB, Pisters R, Nieuwlaat R et al. Progression from paroxysmalto persistent atrial fibrillation: clinical correlates and prognosis. J Am Coll Cardiol 2010; 55: 725–731.
- Luo W1, Huaibin W1, Wenjun Z1, Jie T1, Xiaokang O1, Zi W1, Yujian M1. Predictors of postoperative atrial fibrillation after isolated on-pump coronary artery bypass grafting in patients ≥60 years old. Kardiol Pol 2018;76(1):195-201
- Camm AJ, Lip GY, De Caterina R, Savelieva I, Atar D, Hohnloser SH, et al. 2012 focused update of the ESC Guidelines for the management of atrial fibrillation: an update of the 2010 ESC Guidelines for the management of atrial fibrillation. Developed with the special contribution of the European Heart RhythmAssociation. Eur Heart J 2012; 33(21):2719–47.
- Curtis AB. Update on the clinical management of atrial fibrillation: guidelines and beyond. Postgrad Med 2011; 123(6):7–20.