Predicting postoperative atrial fibrillation after myocardial revascularization without cardiopulmonary bypass: A retrospective cohort study

Abstract

Introduction Considering the threat imposed by postoperative atrial fibrillation (POAF) after coronary artery bypass grafting (CABG) and the potential benefits of off‐pump CABG, the objective of this study was to describe the incidence and identify predictor factors for POAF in patients undergoing CABG without cardiopulmonary bypass (CPB). Methods In this retrospective cohort study, we enrolled patients undergoing CABG without CPB between December 2008 and December 2011. The independent variables evaluated in this study were major patients' characteristics (age, sex, and ethnia), associated comorbidities (systemic arterial hypertension, diabetes mellitus, thyroid dysfunction, chronic renal failure (CRF), chronic obstructive pulmonary disease, and ischemic stroke), and the revascularization approach (the number of grafts used, the revascularized branch, and the choice of vascular graft (arterial or venous). The dependent variable was the onset of atrial fibrillation after the procedure. Results Two hundred and eighty patients were included in the present study. The overall incidence of POAF after off‐pump CABG was 5.0%. In the univariate analysis, the presence of chronic renal failure (odds ratio [OR], 3.01 [1.00‐9.06], P = .049) and the use of venous‐origin graft alone (OR, 9.67 [1.15‐81.56], P = .037) were associated with an increased risk or POAF. These findings were confirmed after multivariate analysis, for both CRF (OR, 3.31 [1.05‐10.46], P = .042) and the use of venous‐origin graft alone (OR, 9.81 [1.13‐85.35], P = .039). Conclusion Off‐pump coronary artery bypass grafting proved a safe and effective procedure, with low postoperative atrial fibrillation occurrence, for myocardial revascularization. Chronic renal insufficiency and the use of venous‐origin graft solely proved to be independent predictor factors for PAOF.

New-Onset Atrial Fibrillation after Off-Pump Coronary Artery Bypass Grafting: Predictors and In-hospital Complications

“…within the incidence of prior studies [1][2] [3] . Age is one of the most consistent risk factors for postoperative AF in many previous literature [4] [15] , which was also supported by our research.…”

Postoperative Atrial Fibrillation after Minimally Invasive Direct Coronary Artery Bypass: A Single-Center, 5-Year Follow-Up Study

“…To our knowledge, higher thyroid hormone level is associated with increased risk for AF and a prolonged total atrial conduction time (TACT). Additionally, thyroid hormone enhanced the effect of angiotensin II in the atrial myocytes, which can induce atrial hypertrophy and cause atrial remodeling, which is an important reason for POAF [Dietrich 2015;Vidotti 2019]. Although the binary logistic regression analysis did not show an independent risk factor of POAF, we still need to pay attention to this situation in the preoperative management of patients.…”

Perioperative risk factors for new‐onset postoperative atrial fibrillation among patients after isolated coronary artery bypass grafting: A retrospective study

“…The incidence of new‐onset POAF ranged from 20 to 40% of CABG patients (Higgs et al, 2020; Khan et al, 2019). Despite advanced developments in surgical techniques and guidelines for the prevention of new‐onset POAF after CABG surgery, the incidence of new‐onset POAF has not been changed over the years (Vidotti et al, 2019; Yamashita et al, 2019). Previous studies have reported that POAF has a high risk of longer ICU stay, unexpected ICU readmission, increased risk of stroke and higher in‐hospital mortality when compared with those who do not have POAF (Higgs et al, 2020; LaPar et al, 2014; Phan et al, 2015).…”

“…As POAF is associated with the increased morbidity and mortality, recent studies have reported that advanced age and pre‐existing comorbidities such as atrial fibrillation, renal failure and heart failure significantly increase the risk of POAF after CABG (Dobrev et al, 2019; Farouk et al, 2018; Greenberg et al, 2017; Gudbjartsson et al, 2020). However, these studies were limited to a certain period, such as preoperative or postoperative, during which they identified the comprehensive risk factors (Higgs et al, 2020; Mangi et al, 2019; Vidotti et al, 2019). Additionally, the risk factors identified in previous studies have been primarily focused on Western populations who underwent CABG (Gudbjartsson et al, 2020; Higgs et al, 2020; Khan et al, 2019).…”

“…Moreover, the results from previous studies on new‐onset POAF after CABG have been controversial or inconsistent. Possible explanation for this gap may be related to an interference from pre‐existing atrial fibrillation or combining cardiac surgery (Higgs et al, 2020; Vidotti et al, 2019; Yamashita et al, 2019). Thus, identifying risk factors for new‐onset POAF after isolated first‐time CABG surgery considering perioperative periods may help cardiac patients to be informed about expected postoperative risks and may facilitate the initiation of individualized care plans to mitigate risk.…”