Atrial fibrillation independently prolongs hospital stay after coronary artery bypass surgery

Abstract

Background: Atrial fibrillation (AF) is the most common arrhythmia occurring in patients after coronary artery bypass surgery (CABG). Hypothesis: The purpose of this study was to determine whether AF independently prolonged postoperative length of stay (LOS). Methods: Consecutive patients undergoing elective CABG were identified. Baseline clinical variables, postoperative course including the development of AF, and postoperative LOS were recorded. Results: In all, 216 patients (aged 61 ± 13 years) were examined. Postoperative LOS was 11.3 ± 6.4 days (median LOS = 9 days). Fifty‐five patients (25%) developed AF. Among 16 variables examined, the univariate predictors of LOS included age (p < 0.001), preoperative left ventricular ejection fraction (p < 0.001), absence of a prior smoking history (p < 0.05), bypass limited to venous conduits (p < 0.001), postoperative AF (p < 0.001), and the occurrence of a postoperative event (p < 0.001). Length of stay for patients who developed AF was significantly longer than that for patients who did not (15.1 ± 9.0 vs. 10.0 ± 4.6 days, p < 0.001). After adjusting for other significant variables, the occurrence of AF after CABG independently prolonged LOS: patients who developed AF stayed 3.2 ± 1.7 days longer than patients who did not (p < 0.001). Conclusions: Atrial fibrillation lengthens hospital stay after CABG, and its effect is independent of other important variables. Identification of patients who are at risk for AF and successful treatment to prevent AF will likely contribute to major reductions in consumption of health care resources in patients with CABG.

Role of postoperative use of adrenergic drugs in occurrence of atrial fibrillation after cardiac surgery

“…[1][2][3][4][5] Age, atrial ischemia, intraoperative elements, postoperative fluctuations in autonomic tone, and postoperative sympathetic activation are the factors suggested as predictors of AF development after cardiac surgery. [1][2][3][4][5][6][7] Adrenergic drugs are used commonly after cardiac surgery to improve cardiac output and to raise blood pressure. The use of these drugs sets a higher catecholamine stage, which, theoretically, may trigger postoperative AF.…”

Ivabradine Versus Beta-Blockers in Patients with Conduction Abnormalities or Left Ventricular Dysfunction Undergoing Coronary Artery Bypass Grafting

“…Atrial fibrillation is the most common complication which occurs after cardiac surgery, with frequencies ranging from 30% after coronary artery bypass grafting, 40% after valve surgery, and 50% after combined coronary artery bypass grafting/valve surgery (Camm et al, 2010). Development of atrial fibrillation immediately after coronary artery bypass grafting results in longer intensive care unit and hospital stays (Villareal et al, 2004;Tamis & Steinberg, 2000), and a significantly higher (two-to three-fold) Table 3. Relative risks for the composite efficacy and safety endpoint of 30-days mortality, in-hospital atrial fibrillation/arrhythmias, in-hospital atrioventricular block/need for pacing, or in-hospital heart failure worsening in metoprolol versus ivabradine-treated patients risk of postoperative stroke (Villareal et al, 2004;Reed et al, 1988).…”

Drug-Induced Atrial Fibrillation

“…[23] The outcomes of druginduced AF in this population have not been assessed but the development of AF following cardiac surgery prolongs duration of hospital stay and increases morbidity. [24,25] The incidence of dobutamine induced AF is unclear in non-surgical patients with acute decompensated heart failure due to the lack of an appropriate comparator group. The best data available regarding dobutamine-induced AF in patients with acute decompensated heart failure was from clinical trials for levosimendan where dobutamine was used as the comparator drug.…”

“…[35] Post-operative AF increases the length of hospital stay and may been associated with increased mortality. [24,25] In summary, the use of milrinone for heart failure increases the risk of AF. Similar to dobutamine, the clinical use of milrinone should not be deterred during acute decompensated heart failure due to its ability to induce-AF.…”