Predictors of postoperative atrial fibrillation persisting beyond hospital discharge after coronary artery bypass grafting

Abstract

Objective: Minimal invasive extracorporeal circuits (MiECC) have been associated with a significant reduction in the incidence of postoperative atrial fibrillation (AF). Nevertheless, AF remains one of the most common complications following elective primary coronary artery bypass grafting (CABG). The aim of this study was to identify the predictors of AF persisting beyond the hospital stay in elective primary CABG patients. Methods: We conducted a retrospective analysis for the predictors of AF that persisted beyond discharge between all patients who received an elective isolated CABG in our institution between 2009 and 2014. Patients with a positive history for intermittent or persistent AF were excluded from the analysis. Almost all patients were discharged to a rehabilitation facility where they stayed for 3 to 4 weeks postoperatively. At rehab approximately 91% of them received Holter monitoring at least once prior to their discharge. Results: A total of 770 patients were included in the analysis of which 763 patients survived the in-hospital stay. The incidence of AF at hospital discharge was 4.2% (32/763) while that on Holter monitor at Rehab was 1.5% (10/685). Age and the type of extracorporeal circuit (ECC) utilized were the only significant predictors for both AF at discharge ( p < 0.01 both) and on Holter monitor in rehab ( p < 0.01 and 0.02, respectively). This was also confirmed on multivariate analysis. Conclusion: Our findings show that the benefits of MiECC regarding the incidence of postoperative AF persist beyond hospital discharge. They may thus positively influence the outcomes of patients beyond the early postoperative period.

2021 MiECTiS focused update on the 2016 position paper for the use of minimal invasive extracorporeal circulation in cardiac surgery

“…There is increasingly solid evidence coming from large-scale studies 59 and meta-analyses demonstrating a reduced incidence of postoperative AF with MiECC use. 47,49,51 However, one recent single-centre randomized study of 240 patients reported no difference in AF between both arms (MiECC and cCPB) after coronary surgery.…”

Diagnostic and Prognostic Value of miRNAs after Coronary Artery Bypass Grafting: A Review

“…Factors such as atrial dilation, ischemia, inflammation, atrial remodeling, trauma, autonomic imbalance and post-extracorporeal circulation could all contribute to AF after a CABG procedure [ 131 ]. At the same time, minimal invasive extracorporeal circuits have been associated with a significant reduction in the incidence of POAF [ 132 ]. POAF was associated with a lower survival rate compared to patients remaining in sinus rhythm at the 10-year follow-up (65.5% vs. 75.3%) [ 133 ].…”