Atrial fibrillation and changes in serum and urinary electrolyte levels after coronary artery bypass grafting surgery

Švagždienė, Milda; Širvinskas, Edmundas; Benetis, Rimantas; Ralienė, Laima; Šimatonienė, Violeta

doi:10.3390/medicina45120123

Cited by 16 publications

(13 citation statements)

References 16 publications

(9 reference statements)

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“…The use of magnesium in the preoperative and early postoperative periods is highly effective in reducing incidence of POAF after CABG [ 115 ], and magnesium can be considered as the antiarrhythmic drug of choice in depleted patients [ 11 ]. On the other hand, magnesium sulphate infusion does not decrease the rate of postoperative atrial fibrillation during the early postoperative period in normomagnesemic patients [ 116 ].…”

Section: Pathophysiology and Nonpharmacologic Treatmentmentioning

confidence: 99%

Postoperative Atrial Fibrillation

2011

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Postoperative atrial fibrillation (POAF) is common among surgical patients and associated with a worse outcome. Pathophysiology of POAF is not fully disclosed, and several perioperative factors could be involved. Direct cardiac stimulation from perioperative use of catecholamines or increased sympathetic outflow from volume loss/anaemia/pain may play a role. Metabolic alterations, such as hypo-/hyperglycaemia and electrolyte disturbances, may also contribute to POAF. Moreover, inflammation, both systemic and local, may play a role in its pathogenesis. Strategies to prevent POAF aim at reducing its incidence and ameliorate global outcome of surgical patients. Nonpharmacological prophylaxis includes an adequate control of postoperative pain, the use of thoracic epidural analgesia, optimization of perioperative oxygen delivery, and, possibly, modulation of surgery-associated inflammatory response with immunonutrition and antioxidants. Perioperative potassium and magnesium depletion should be corrected. The impact of those interventions on patients outcome needs to be further investigated.

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Section: Pathophysiology and Nonpharmacologic Treatmentmentioning

confidence: 99%

Postoperative Atrial Fibrillation

2011

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“…We included 20 randomized controlled trials [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34] with a total of 2,430 patients -1,196 patients in Mg supplementation group, while 1,234 patients in the placebo group. [ Table 1] describes the baseline characteristics of included studies including patient demographics, Mg regimens, and incidence of POAF.…”

Section: Resultsmentioning

confidence: 99%

“…This included information about study design, patient characteristics (age, gender, Mg supplementation, POAF, length of stay, aortic cross clamp time and follow up period). Jadad score was independently calculated by 2 investigators (RC and JG) [ Table 1] [34] . Any disparities between the two investigators were discussed with a third investigator (MT) until consensus was reached.…”

Section: Data Extraction and Quality Appraisalmentioning

confidence: 99%

Role of Prophylactic Magnesium Supplementation in Prevention of Postoperative Atrial Fibrillation in Patients Undergoing Coronary Artery Bypass Grafting: a Systematic Review and Meta-Analysis of 20 Randomized Controlled Trials.

Chaudhary

Garg

Turagam

et al. 2019

Journal of Atrial Fibrillation

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Background : Several randomized trials have evaluated the efficacy of prophylactic magnesium (Mg) supplementation in prevention of post-operative atrial fibrillation (POAF) in patients undergoing cardiac artery bypass grafting (CABG). We aimed to determine the role of prophylactic Mg in 3 different settings (intraoperative, postoperative, intraoperative plus postoperative) in prevention of POAF. Methods: A systemic literature search was performed (until January 19, 2019) using PubMed, EMBASE, Web of Science, and Cochrane Central Register of Controlled Trials to identify trials evaluating Mg supplementation post CABG. Primary outcome of our study was reduction in POAF post CABG. Results: We included a total of 2,430 participants (1,196 in the Mg group and 1,234 in the placebo group) enrolled in 20 randomized controlled trials. Pooled analysis demonstrated no reduction in POAF between the two groups (RR 0.90; 95% CI, 0.79-1.03; p=0.13; I 2 =42.9%). In subgroup analysis, significant reduction in POAF was observed with postoperative Mg supplementation (RR 0.76; 95% CI, 0.58-0.99; p=0.04; I 2 =17.6%) but not with intraoperative or intraoperative plus postoperative Mg supplementation (RR 0.77; 95% CI, 0.49-1.22; p = 0.27; I 2 =49% and RR 0.92; 95% CI, 0.68-1.24; p = 0.58; I 2 =51.8%, respectively). Conclusions: Magnesium supplementation, especially in the postoperative period, is an effective strategy in reducing POAF following CABG.

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“…Besides that, magnesium supplementation pre-operatively or early post-operative period in hypomagnesemia patients has shown to be preventative of AF. This effect is not apparent in those who have normal magnesium levels post-operatively 22 – 25 .…”

Section: Introductionmentioning

confidence: 94%

A retrospective study on atrial fibrillation after coronary artery bypass grafting surgery at The National Heart Institute, Kuala Lumpur

et al. 2018

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Background: Atrial fibrillation (AF) is common after cardiac surgery and has been associated with poor outcome and increased resource utilization. The main objective of this study is to determine the incidence of POAF in Malaysia and identify the predictors of developing POAF. The secondary outcome of this study would be to investigate the difference in mortality and morbidity rates and the duration of intensive care unit (ICU), high dependency unit (HDU) and hospital stay between the two. Methods: This is a retrospective single-center, cross sectional study conducted at the National Heart Institute, Malaysia. Medical records of 637 who underwent coronary artery bypass grafting (CABG) surgery in 2015 were accrued. Pre-operative, operative and post-operative information were subsequently collected on a pre-formulated data collection sheet. Data were then analyzed using IBM SPSS v23. Results: The incidence of POAF in our study stands at 28.7% with a mean onset of 45±33 hours post operatively. Variables with independent association with POAF include advancing age, Indian population, history of chronic kidney disease, left ventricular ejection fraction and beta-blocker treatment. The mortality rate is significantly higher statistically ( p < 0.05), and similarly the incidence of stroke. The incidence of other post-operative complications was also significantly higher statistically. The duration of ICU, HDU and hospital stays were statistically longer ( p < 0.001) with higher rates of ICU readmissions and reintubations seen. Conclusion: We conclude that the incidence of POAF in Malaysia is comparable to the figures in Western countries, making POAF one of the most commonly encountered condition after CABG with similar higher rates of mortality, poor outcomes and longer duration of stay, and therefore increased cost of care. Strategies to reduce the incidence of AF after cardiac surgery should favorably affect surgical outcomes and reduce utilization of resources and thus lower cost of care.

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Atrial fibrillation and changes in serum and urinary electrolyte levels after coronary artery bypass grafting surgery

Abstract: Correspondence to E. Širvinskas,

Cited by 16 publications

References 16 publications

Postoperative Atrial Fibrillation

Postoperative Atrial Fibrillation

Role of Prophylactic Magnesium Supplementation in Prevention of Postoperative Atrial Fibrillation in Patients Undergoing Coronary Artery Bypass Grafting: a Systematic Review and Meta-Analysis of 20 Randomized Controlled Trials.

A retrospective study on atrial fibrillation after coronary artery bypass grafting surgery at The National Heart Institute, Kuala Lumpur

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