Postoperative Atrial Fibrillation Among Patients Undergoing Isolated Coronary Artery Bypass Grafting

Abstract

Introduction Postoperative atrial fibrillation (AF) is the commonest of all the known cardiac arrhythmias after cardiac surgery. The postoperative AF has both short- and long-term adverse impacts on patients, like prolonged intensive care unit (ICU) stay, increased frequency of reoperations, myocardial infarction, increased use of inotropes, and intra-aortic balloon pump (IABP). There is a paucity of data regarding the postoperative AF after isolated coronary artery bypass grafting (CABG) and its risk factors in our geographic location. Therefore, the aim of this study was to determine the frequency of postoperative atrial fibrillation among patients undergoing isolated CABG at a tertiary care hospital of Karachi, Pakistan. Methods This prospective observational study was conducted on 163 consecutively selected patients undergoing first time isolated CABG at the Department of Cardiothoracic Surgery, Aga Khan University Hospital, Karachi. Patients with redo-sternotomy, preoperative atrial fibrillation and with other cardiac pathology were excluded from the study. Postoperative AF was defined in the patients with postoperative 12-lead electrocardiographic (ECG) finding of absence of P waves, replaced by unorganized electrical activity and irregular R-R intervals. Data analysis was carried out using IBM SPSS Statistics for Windows, Version 21.0 (IBM Corp., Armonk, NY, USA). Results A total of 163 patients were enrolled with the mean age of 58.66 ± 9.77 years ranging between 40 and 85 years with male predominance of 81% (132). The most common comorbidity was hypertension in about 68.1% (111), followed by diabetes mellitus in 54.6% (89) patients. Postoperative AF was observed in 42 (25.8%) patients. Most of the patients who developed postoperative AF, were overweight with mean body mass index (BMI) of 27.04 ± 4.85 kg/m 2 , 76.2% (32) had a history of hypertension, diabetes mellitus was associated with 33.3% (14) patients with postoperative AF and 50.0% (21) of them were smokers. Distribution of coronary artery disease in patients with postoperative AF was observed as three vessels coronary artery disease (3VCAD) in 83.3% (35), two-vessel coronary artery disease (2VCAD) was present in 7.1% (three), and rest of 9.5% (four) patients had single-vessel coronary artery disease (SVCAD). Conclusion The frequency of postoperative atrial fibrillation in our study was found to be 25.9% which is comparable to world literature. An important finding that comes through this study is a younger population undergoing CABG, which raises the possibility of early manifestation of ischemic heart disease in our region. This, however, needs further investigation. We were unable to point out the factors predictive of postoperative AF; studies with larger sample size would help in that regard.

Operative Mortality of Coronary Artery Bypass Grafting in Patients With Low Serum Albumin After Nutritional Support

“…22 In our study, we found a higher incidence of post-op atrial fibrillation of around 39.5%, while another study reported it to be around 25.8% showing a clear association with BMI. 25 Limitation of the study: The small sample size of our study does limit its applicability and generalization. The main limitations of the present study include a single-centre experience with a non-randomized design.…”

Comparison of Anticoagulants for Postoperative Atrial Fibrillation After Coronary Artery Bypass Grafting: A Pilot Study

“…In addition, AF is common after cardiac surgeries, such as CABG, occurring in approximately 20% of patients in the early postoperative period. [1][2][3][4][5] While usually self-limiting, anticoagulation is recommended for patients with recurrent or persistent AF after CABG, as the thromboembolic risks of POAF are similar to that of nonsurgical AF. [6][7][8][9] The ICU length of stay was longer for patients randomized to receive apixaban (2.14 versus 1.43 days, P ¼ .016; Table 2).…”

“…Atrial fibrillation (AF) after coronary artery bypass graft surgery (CABG) is common, occurring in approximately 20% of patients. [1][2][3][4][5] Postoperative atrial fibrillation (POAF) adversely impacts patient outcomes, and patients who develop POAF are at increased risk of stroke, prolonged hospitalization, and other thromboembolic complications. Occurring in the early postoperative period, POAF is usually treated with pharmacologic rate control agents, potentially in combination with rhythm control agents or electrical cardioversion.…”

Clinical characteristics and prognostic factors of atrial fibrillation at a tertiary center of Pakistan – From a South-Asian perspective – A cross-sectional study

“…In an observational study, more than 6% of the acute hospital admissions in Pakistan were due to atrial fibrillation [ 11 ]. Another study identified an incidence of 26% in patients undergoing coronary artery bypass grafting (CABG) [ 12 ].…”