Predictors of Atrial Fibrillation following Coronary Artery Bypass Grafting

Sabzi, Feridoun; Zokaei, Abdolhamid; Moloudi, Abdol Rasoul

doi:10.4137/cmc.s7170

Cited by 24 publications

(26 citation statements)

References 43 publications

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“…Opium, a mixture of several opioids like morphine and codeine, is associated with AF as well, according to a few other studies. In a retrospective study conducted by Sabzi et al [127] on 670 patients undergoing coronary artery bypass grafting, opium consumption was associated with post-operative AF and was introduced as a new predictor of AF incidence in these patients [127]. Correspondingly, Mirzaiepour et al [128] confirmed these results in a report on a patient after MI.…”

Section: Atrial Fibrillation and Post-myocardial Infarction Arrhythmiasupporting

confidence: 74%

Opioids and Cardiac Arrhythmia: A Literature Review

2018

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Objective: One of the most important side effects of opioids is their influence on the electrical activity of the heart. This review focusses on the effects of opioids on QT interval prolongation and their arrhythmogenic liability. Methods: By using various keywords, papers published up to 2018 in different databases were searched and identified. The search terms were opioids names, corrected QT interval, human-ether-a-go-go gene, torsades de pointes (TdP), cardiac arrhythmias, opioid dependence and other relevant terms. It emphasized the effects of each opioid agent alone on electrocardiogram (ECG) and some interactions. Results: Available data indicate that some opioids such as methadone are high-risk even at low doses, and have potential for prolongation of the QT interval and development of TdP, a dangerous ventricular tachycardia. A number of opioids such as tramadol and oxycodone are intermediate risk drugs and may develop long QT interval and TdP in high doses. Some other opioids such as morphine and buprenorphine are low-risk drugs and do not produce QT interval prolongation and TdP at least in routine doses. Opium-consumers are at higher risk of supra-ventricular arrhythmias, sinus bradycardia, cardiac block and atrial fibrillation. Conclusion: The cardiac arrhythmogenicity of various opioids is different. Methadone has a higher capability to induce long QT interval and dangerous arrhythmias in conventional doses than others. To reduce of arrhythmogenic risk, high doses of opioids must be used cautiously with periodic monitoring of ECG in high-risk consumers such as patients under opioid maintenance treatment.

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Section: Atrial Fibrillation and Post-myocardial Infarction Arrhythmiasupporting

confidence: 74%

Opioids and Cardiac Arrhythmia: A Literature Review

2018

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“…Several authors have compared the blunting of the hemodynamic response to tracheal intubation when using manual administration of different opioids 6,10,11,12,13 however comparison of target-controlled infusion (TCI) of remifentanil and sufentanil which are technically available in commercial TCI pumps is also necessary because of the frequent use of these two opioids in daily anesthesia practice. Hence we believe our study is novel and constitutes the first comparison of these two drugs for this goal.…”

Section: Introductionmentioning

confidence: 99%

Comparison of target-controlled infusion of sufentanil and remifentanil in blunting hemodynamic response to tracheal intubation

Yeganeh

Roshani²,

Latifi³

et al. 2013

J Inj Violence Res

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Abstract:Background:Maintaining blood pressure (BP) and heart rate (HR) after laryngoscopy and tracheal intubation has always been a concern in injured patients. Opioids can attenuate or stop an increase in these two parameters if administered with proper doses or targets in target-controlled infusion (TCI). Remifentanil and sufentanil are widely used for this purpose because their cardiac side effects are low and, especially in traumatic patients, they are tolerated well. A comparison of the benefits and limitations of these two opioids in TCI is much needed. A literature review in electronic data bases revealed few results. Methods:40 normotensive patients were enrolled to this randomized clinical trial study. After BIS guided anesthesia with a target-controlled propofol infusion and muscle relaxation with cisatracurium, remifentanil and sufentanil were infused using TCI with 2 and 0.2 ng.ml-1 targets respectively. BP and HR were recorded for five data points and compared with Fischer's exact test. Results:Systolic, mean and diastolic arterial pressure and HR in different points of the study remained below baseline values but were out of control in some cases, however the out-of-control values showed significant difference between the two groups only for heart rate changes. The relative risk for producing out-of-control changes with remifentanil compared to sufentanil is significantly more than 1 for HR decrease. Conclusions:Sufentanil produced more common pre-intubation hypotension than remifentanil in propofol anesthetized patients but this hypotension disappeared sooner than remifentanil after tracheal intubation. Both opioids prevent an increase in BP and HR after tracheal intubation but the side effects (hypotension and bradycardia) may be a cause for concern (IRCT138710011361N3).

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“…Advanced age strongly associated with POAF is the only consistent finding in all the studies (2,(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21).…”

Section: Discussionmentioning

confidence: 57%

“…The predictive value of different analyzed models was in-fluenced by the variables involved and the number of patients included. Studies reporting risk factors for POAF have described different variables, but there are only a few prediction models, mainly for patients undergoing coronary artery bypass grafting (CABG) or combined surgical procedures (9,10,(14)(15)(16). Our aim was to test a population of patients undergoing SAVR, excluding other surgical procedures such as CABG or mitral valve surgery.…”

Section: Discussionmentioning

confidence: 99%

Postoperative atrial fibrillation prediction following isolated surgical aortic valve replacement

Iliescu¹

2018

Anatol J Cardiol

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ObjectivePostoperative atrial fibrillation (POAF) is the most common complication following cardiac surgery, with increased risk of stroke and high mortality. Our aim was to identify patients at risk and to design a model that could predict POAF.MethodsIn this single center study, we evaluated 1191 patients requiring isolated surgical aortic valve replacement between January 2000 and June 2014. The patients were followed during the early postoperative period until discharge.ResultsAF occurred in 342 patients (28.71%). Six variables associated with high arrhythmic risk [advanced age, body mass index, tricuspid regurgitation, prolonged ventilation, longer intensive care unit stay, and dilated left atrium (LA; volume ≥35 ml/m2)] were selected to create a multivariate prediction model. This model predicted POAF in 64.7% of cases, with a moderate discriminative power (AUC=0.65; p=0.001; 95% CI, 0.571-0.771). We also developed the CHAID (Chi-square automatic interaction detection) model showing multilevel interactions among risk factors for POAF. Age had the greatest discriminative power, with patients aged >68 years at a higher risk for POAF. In low-risk patients, the subgroup with dilated LA (volume ≥40 ml) was more prone to develop POAF. For the intermediate-risk group, history of AF was the next deciding variable, whereas for the high-risk group, it was tricuspid regurgitation (at least moderate).ConclusionThe multivariate logistic model has an acceptable predictive value. CHAID-derived model is a new tool that could be easily applied to identify patients requiring prophylactic regimens.

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Predictors of Atrial Fibrillation following Coronary Artery Bypass Grafting

Cited by 24 publications

References 43 publications

Opioids and Cardiac Arrhythmia: A Literature Review

Opioids and Cardiac Arrhythmia: A Literature Review

Comparison of target-controlled infusion of sufentanil and remifentanil in blunting hemodynamic response to tracheal intubation

Postoperative atrial fibrillation prediction following isolated surgical aortic valve replacement

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