Prognostic factors of atrial fibrillation following coronary artery bypass graft surgery

Kievišas, Mantas; Keturakis, Vytenis; Vaitiekūnas, Egidijus; Dambrauskas, Lukas; Jankauskienė, Loreta; Kinduris, Šarūnas

doi:10.1007/s11748-017-0797-6

Cited by 8 publications

(9 citation statements)

References 32 publications

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“…Previous studies confirmed that age is a risk factor of POAF, which may be related to the retrogressive changes of heart, especially the atrial structure and function [Clement 2019;Kievisas 2017;Amar 2002]. In our study, this result is verified by the binary logistic regression analysis.…”

Section: Baseline Characterssupporting

confidence: 86%

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

Fan¹,

Liu²,

Dong³

et al. 2021

HSF

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Objective: To evaluate the risk factors and explore the mid-term outcomes of postoperative atrial fibrillation (POAF) after minimally invasive direct coronary artery bypass (MIDCAB). Methods: A total of 165 patients, who underwent isolated MIDCAB from 2012 to 2015, were enrolled in the study and retrospectively reviewed. Patients with preoperative arrhythmia, concomitant surgical procedures were excluded. All patients were continuously monitored for POAF until discharge, and two groups were formed: the non-POAF group (140 patients, 71.4% men, mean age 58.83±10.3 years) and the POAF group (25 patients, 84.0% men, mean age 64.52±9.0 years). Early and mid-term outcomes were evaluated, perioperative factors associated with POAF were analyzed with a binary logistic regression model, and the relationship between POAF and major adverse cardiac event (MACE) was analyzed with Cox regression model. Results: The incidence of POAF in this study was 15.15%. Patients in the POAF group had a significant higher risk of re-entry to ICU (2 cases: 2 cases=8.0%: 1.4%, P = 0.049), renal failure (2 cases: 1 case=8.0%: 0.7%, P = 0.018), and death (1 case: 0 case=4.0%: 0%, P = 0.018). Binary logistic regression showed gender (male), age were independent risk factors of POAF (P = 0.038, 95% confidence interval 1.082-16.286; P = 0.011, 95% confidence interval 1.015-1.117, respectively), preoperative ACEI or ARB usage was a protective factor of POAF (P = 0.010, 95% confidence interval 0.113-0.748). With a 5-year follow up, the overall MACE rate showed no statistical difference between the two groups (P = 0.067). Conclusions: POAF after MIDCAB was related to postoperative morbidities, such as re-entry to ICU, renal failure, and death. Gender (male) and age were independent risk factors, while preoperative ACEI or ARB usage was a protective factor. POAF has not associated the occurrence of MACE with a mid-term follow-up.

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Section: Baseline Characterssupporting

confidence: 86%

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

Fan¹,

Liu²,

Dong³

et al. 2021

HSF

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“…36,41,[58][59][60] Pre-existing valvular disease has also been linked to an increased risk of POAF (Table 1), with the largest risk attributed to the extent of mitral valve disease. 48,56,61 Preoperative echocardiogram changes in left atrial anatomy secondary to diastolic dysfunction also show a strong link with POAF; these include atrial dilatation, hypertrophy, increased volume and increasing left atrial volume indexed to body area (LAV i ) (Table 1), which is thought to be the greatest predictive factor of these. 48,49,[59][60][61][62][63][64][65] Novel two-dimensional speckle-tracking echocardiography (2D-STE) has shown that longitudinal strain and augmented left ventricular twist and untwisting velocity identified prior to cardiac surgery correlates with POAF incidence.…”

Section: Risk Factors Identified On Routine Preoperative Investigationsmentioning

confidence: 99%

“…48,56,61 Preoperative echocardiogram changes in left atrial anatomy secondary to diastolic dysfunction also show a strong link with POAF; these include atrial dilatation, hypertrophy, increased volume and increasing left atrial volume indexed to body area (LAV i ) (Table 1), which is thought to be the greatest predictive factor of these. 48,49,[59][60][61][62][63][64][65] Novel two-dimensional speckle-tracking echocardiography (2D-STE) has shown that longitudinal strain and augmented left ventricular twist and untwisting velocity identified prior to cardiac surgery correlates with POAF incidence. 49,64,65 Medications A wealth of literature supports the prophylactic use of preoperative beta-blockers against POAF (OR: 0.33; 95% CI).…”

Section: Risk Factors Identified On Routine Preoperative Investigationsmentioning

confidence: 99%

“…1,7,26,40,45 Prior to surgery, all patients should have an ECG and echocardiogram performed to inform risk stratification. 40,44,[53][54][55][56][57][58][59][60][61][62][63][64][65] The use of universal preoperative betablockers has a strong evidence base, with amiodarone and sotalol proving effective. 23,24,26,27,29,30,51,66 More data is required to determine the timing of administration to provide optimal prophylaxis.…”

Section: Preoperative Factorsmentioning

confidence: 99%

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Optimising risk factors for atrial fibrillation post-cardiac surgery

et al. 2021

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Postoperative atrial fibrillation (POAF) is an ongoing complication following cardiac surgery, with an incidence of 15%–60%. It is associated with substantial mortality and morbidity, as well increased hospital stays and healthcare costs. The pathogenesis is not fully understood, but the literature suggests that POAF occurs when transient, postoperative triggers act on vulnerable atrial tissue produced by preoperative, procedure-induced and postoperative processes such as inflammation, oxidative stress, autonomic dysfunction and electrophysiological remodelling of the atrial tissues. This sets the stage for arrhythmogenic mechanisms, such as ectopic firing secondary to triggered activity and re-entry mechanisms generating POAF. Preoperative factors include advanced age, sex, ethnicity, cardiovascular risk factors, preoperative drugs, electrocardiogram and echocardiogram abnormalities. Procedural factors include: the use of cardiopulmonary bypass and aortic cross clamp, type of cardiac surgery, use of hypothermia, left ventricular venting, bicaval cannulation and exclusion of the left atrial appendage. Postoperative factors include postoperative drugs, electrolyte and fluid balance and infection. This review explores the pathogenesis of POAF and the contribution of these perioperative factors in the development of POAF. Patients can be risk stratified for targeted treatment and prophylaxis, and how these factors can be attenuated to improve POAF outcomes following cardiac surgery.

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“… 7 , 8 Risk factors include age, history of arrhythmia, complexity and duration of surgery, cardiac hypertrophy or larger left atrial volume, bleeding, electrolyte abnormalities, and impaired renal function. 3 , 9 , 10 …”

Section: Introductionmentioning

confidence: 99%