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To investigate the impact of pre-operative autonomic balance and atrial ectopic activity on the risk of atrial fibrillation or flutter after aorto-coronary artery bypass surgery 24-h Holter monitoring was analysed in 102 patients before coronary artery bypass grafting. Index for vagal tone was calculated as % successive RR interval differences > 6%. Twenty-nine (28%) of the 102 patients developed atrial fibrillation or flutter. Independent predictors (90% confidence interval) of postoperative atrial fibrillation or flutter were identified by logistic regression analysis: the independent predictors were older age, relative risk 1.07.year-1 (1.02-1.12), vagal index < 10%, relative risk 4.50 (1.40-14.5), > or = 10 ectopic supraventricular beats . 24 h-1, relative risk 3.03 (1.05-8.72), and one or more events of non-sustained supraventricular tachycardia, relative risk 3.02 (1.11-8.22). Thus, age of the patient, attenuated pre-operative cardiac vagal modulation, ectopic supraventricular beats, and paroxysmal non-sustained supraventricular tachycardia are independent risk factors for the development of atrial fibrillation or flutter after coronary artery bypass surgery.

Background Knowledge of chronic opioid use after cardiac surgery is sparse. We therefore aimed to describe the proportion of new chronic post‐operative opioid use after open cardiac surgery. Methods We used prospectively registered data from a national prescription registry and a clinical registry of 29 815 first‐time cardiac surgeries from three Danish university hospitals. Data collection spanned from 2003 to 2016. The main outcome was chronic post‐operative opioid use, defined as at least one opioid dispensing in the fourth post‐operative quarter. Data were assessed for patient‐level predictors of chronic post‐operative opioid use, including pre‐operative opioid use, opioid use at discharge, comorbidities, and procedural related variables. Results The overall proportion of post‐operative opioid use was 10.6% (95% CI: 10.2‐10.9). The proportion of new chronic post‐operative opioid use was 5.7% (95% CI: 5.5‐6.0) among pre‐operative opioid naïve patients. The corresponding proportions among patients, who pre‐operatively used low or high dose opioid (1‐500 mg or > 500 mg cumulative morphine equivalent opioid), were 68.3% (95% CI: 66.1‐70.4) and 76.3% (95% CI: 74.0‐78.5) respectively. Risk factors associated with new chronic post‐operative opioid use included: female gender, underweight and obesity, pre‐operative comorbidities, acute surgery, ICU‐time > 1 day, and post‐operative complications. Strongest predictor of chronic post‐operative opioid use was post‐discharge use of opioid within one month after surgery (odds ratio 3.3, 95% CI: 2.8‐4.0). Conclusion New chronic post‐operative opioid use after open cardiac surgery is common. Focus on post‐discharge opioid use may help clinicians to reduce rates of new chronic opioid users.

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The cumulated incidence of atrial fibrillation or flutter after coronary artery bypass grafting is 30%. The causes of these arrhythmias have not yet been sufficiently identified. We therefore undertook the present study to analyze the possible association of hemodynamic function during the various phases of coronary artery bypass grafting and the later development of atrial fibrillation/flutter. Hemodynamic function was measured with a pulmonary artery catheter in 120 consecutive patients undergoing elective coronary artery bypass surgery. Thirty-five (29%) of the patients developed atrial fibrillation/flutter. Logistic regression analysis identified independent predictors of atrial fibrillation/flutter. After induction of general anesthesia, the relative risk (95% confidence interval) of older age was 1.09/year (1.03-1.16), and the reduction in relative risk by an increase in left ventricular stroke work was 0.96/gm (0.93-0.99). After weaning from the extracorporeal circulation the independent significant predictors were age, relative risk 1.07/year (1.01-1.13), and increased central venous pressure, relative risk 1.12/mm Hg (1.00-1.26). At the time of admission to the intensive care unit, the relative risk of age was 1.10/year (1.03-1.18), and the relative risk of an increased central venous pressure was 1.26/mm Hg (1.06-1.49). However, the best prediction model (prediction after induction of general anesthesia) only provided a median predicted probability of atrial fibrillation/flutter of 0.37 for the patients who had atrial fibrillation/flutter, and a median predicted probability of atrial fibrillation/flutter of 0.20 for the patients without these arrhythmias. We identified possible hemodynamic predictors of atrial fibrillation/flutter after coronary bypass surgery, but the use of a risk stratification for development of atrial fibrillation/flutter based on hemodynamic function cannot be recommended.