Atrial fibrillation after coronary artery bypass grafting: does the type of procedure influence the early postoperative incidence?

Siebert, Janusz; Anisimowicz, Lech; Lango, Romuald; Rogowski, Jan; Pawlaczyk, Rafał; Brzeziński, Michał; Beta, Sebastian; Narkiewicz, M

doi:10.1016/s1010-7940(01)00621-2

Cited by 58 publications

(44 citation statements)

References 16 publications

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“…This is consistent with our previously published findings based on a smaller number of patients [18]. Recently, Bohatch Junior et al [19] demonstrated no significant difference in the incidence of postoperative AF between on-pump and off-pump patients.…”

Section: Discussionsupporting

confidence: 93%

Atrial fibrillation following off-pump versus on-pump coronary artery bypass grafting: Incidence and risk factors

2013

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Background: Postoperative atrial fibrillation (AF) is a common arrhythmia that occurs after coronary artery bypass grafting (CABG). 3% and 19.3% of CABG and OPCAB patients, respectively (p = 0.3). The peak incidence of arrhythmia was observed between the second and third postoperative day in both CABG and OPCAB patients (36% and 41%, respectively). Patient's age and history of hypertension were significant predictors of postoperative AF (OR 1.38, p = 0.0002; and OR 1.38, p = 0.008, respectively). Patients who developed AF vs. without AF had significantly higher rates of complications such as death (3.1% vs. 1.2%, p = 0.01), reoperation (5.2% vs. 2.8%, p = 0.02), and the need to utilize intra-aortic balloon pump (IABP) (6.8% vs. 3.4%, p = 0.002). Use of IABP and reoperation were significant perioperative predictors of the arrhythmia (OR 2.1, p = 0.003; and OR 1.9, p = 0.02, respectively). AF was also associated with a prolonged stay in an intensive care unit (72.5 ± 78.8 for patients with AF vs. 34.6 ± 25.2 for patients with sinus rhythm, p = 0.000001). Conclusions:In patients undergoing CABG, postoperative AF is a common arrhythmia independent of the type of surgical procedure. (Cardiol J 2016; 23, 5: 518-523)

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Section: Discussionsupporting

confidence: 93%

Atrial fibrillation following off-pump versus on-pump coronary artery bypass grafting: Incidence and risk factors

2013

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“…To our knowledge, this is the first report demon- strating an increased risk of new-onset POAF after CABG surgery in patients with fQRS. Atrial fibrillation is a relatively frequent complication of cardiac surgery, occurring in approximately 25%-40% of patients following CABG (15)(16)(17). In our study, POAF occurred in 22.8% of patients who had undergone isolated CABG surgery.…”

Section: Discussionmentioning

confidence: 99%

Fragmented QRS may predict postoperative atrial fibrillation in patients undergoing isolated coronary artery bypass graft surgery

Çetin¹,

Kocaman²,

Durakoğlugil³

et al. 2012

Anadolu Kardiyol Derg

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Fragmented QRS may predict postoperative atrial fibrillation in patients undergoing isolated coronary artery bypass graft surgery Fragmente QRS izole koroner arter baypass greftleme operasyonu geçiren hastalarda postoperatif atriyal fibrilasyon gelişimini öngörebilir ABSTRACTObjective: Fragmented QRS complexes (fQRS) are defined as various RSR′ patterns in 2 contiguous leads corresponding to a major coronary artery territory. Although the reason of association between fQRS and cardiac events was documented as cardiac fibrosis, the predictive role of fQRS was not studied for postoperative atrial fibrillation (POAF) which is a frequent and serious complication in patients undergoing isolated coronary artery bypass graft (CABG) surgery. Therefore, this issue was investigated in the present study. Methods: The current study has a prospective observational design. Two hundred and seventy two eligible patients who underwent isolated CABG surgery were enrolled consecutively. The patients were divided in two groups with post-op atrial fibrillation (AF) and non-AF. The occurrence of new-onset AF following CABG and the relationship with fQRS were searched. The logistic regression analysis was used to determine independent predictors for POAF. The sensitivity and specificity of study variables in predicting POAF were calculated using a receiver-operating characteristic curve (ROC). Results: POAF occurred in 62 of 272 patients (22.8%). Patients with POAF were generally older (p<0.001) and female (p=0.006), with preexisting hypertension (p=0.008), lower hemoglobin levels (p=0.011), chronic obstructive lung disease (p=0.003), prolonged QRS time (p=0.004), and higher EUROSCORE (p<0.001) compared to non-AF patients. Patients with POAF had lower left ventricular ejection fraction (p<0.001) and high fQRS rate (p<0.001), but similar left atrial size (LA, p=NS). Interestingly, LA size was significantly enlarged in patients with fQRS (3.8±0.6 vs. 4.1±0.5 cm, p=0.002). In addition, the patients with POAF had prolonged stay in the cardiac surgery intensive-care unit (p<0.001) and extended in-hospital care (p=0.001). New-onset POAF was significantly related to the presence and number of fQRS. In the logistic regression analysis, only age (OR: 1.044, 95% CI: 1.008-1.082, p=0.016), female gender (OR: 2.347, 95% CI: 1.079-5.106, p=0.031), the presence and number of fQRS (OR: 6.020, 95% CI: 3.152-11.5 and OR: 1.522, 95% CI: 1.282-1.807, both of, p<0.001) were independent predictors of POAF. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and the diagnostic accuracy (DA) of presence of fQRS on pre-op electrocardiogram to predict POAF were 66%, 76%, 45%, 88% and 74%, respectively. The area under ROC was found as 0.733 (p<0.001, 95% CI: 0.657-0.810). Conclusion: In our study, we found that new-onset POAF was independently related to the presence and number of fQRS in patients undergoing CABG surgery. In addition, fQRS on pre-op surface ECG had high predictive values for new-onset POAF. (Anadolu Kard...

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“…9 The use of cardiopulmonary bypass, the type of cardioplegia, presence of myocardial ischemia, and number of grafts placed are all possible factors responsible for the occurrence of postoperative AF. 10 It has been proposed that endogenous adenosine, released due to tissue hypoxia, may cause early (< 48 h) postoperative AF. 5 Cox observed that atrial ischemia following cardiac surgery could induce early AF.…”

Section: Discussionmentioning

confidence: 99%

Role of endogenous adenosine in atrial fibrillation after coronary artery bypass graft

Yavuz

Bertolet

Bebooul

et al. 2004

Clinical Cardiology

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Background: Atrial fibrillation (AF) is the most common complication following coronary artery bypass graft (CABG). The mechanism of AF after CABG is not well defined; however, it is suggested that endogenous adenosine, released in response to tissue hypoxia, may play a mechanistic role in these arrhythmias. Hypothesis: The purpose of this study was to examine whether intravenous theophylline, via adenosine A1 receptor antagonism, would correct or modify new‐onset early (< 48 h post CABG) atrial fibrillation in patients post CABG, and thereby implicate endogenous adenosine as an inciting agent. Methods: A prospective double‐blind, placebo‐controlled study design was applied to 385 consecutive patients with coronary artery disease who had undergone CABG. Any patient who developed AF within 48 h of the operative procedure was randomly assigned to receive 5 mg/kg of intravenous theophylline (Group A) or matched intravenous placebo (Group B). The patients who converted to sinus rhythm within 15 min of drug administration were accepted as showing positive responses. Results: Thirty patients comprised the study group. In Group A, 8 of the 15 patients (53%) converted from AF to sinus rhythm within 15 min of theophylline administration. One patient who converted to sinus rhythm 20 min after theophylline administration was accepted as showing a negative response. In the placebo‐treated group, no patient converted to sinus rhythm within 15 min (p < 0.007 compared with Group A). Conclusions: The mechanism of AF after CABG is not well defined and is probably multifactorial. However, this study demonstrated that antagonism of the adenosine A1 receptor can promptly convert many of these patients back to sinus rhythm, and thereby implicates endogenously released adenosine in a mechanistic role for inciting early (< 48 h) post‐CABG AF.

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Atrial fibrillation after coronary artery bypass grafting: does the type of procedure influence the early postoperative incidence?

Cited by 58 publications

References 16 publications

Atrial fibrillation following off-pump versus on-pump coronary artery bypass grafting: Incidence and risk factors

Atrial fibrillation following off-pump versus on-pump coronary artery bypass grafting: Incidence and risk factors

Fragmented QRS may predict postoperative atrial fibrillation in patients undergoing isolated coronary artery bypass graft surgery

Role of endogenous adenosine in atrial fibrillation after coronary artery bypass graft

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