The role of signal averaged P wave duration and serum magnesium as a combined predictor of atrial fibrillation after elective coronary artery bypass surgery.

Zaman, Azfar; Alamgir, Farquad; Richens, Trevor; Williams, Robbie; Rothman, M. T.; Mills, Peter

doi:10.1136/hrt.77.6.527

Cited by 90 publications

(47 citation statements)

References 29 publications

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“…However, the difference in age between the groups was not large (6 yrs), and it therefore was not possible to identify an AFIB target age. In this study, consistent with most studies, gender was not associated with higher AFIB prevalence rates (1,(15)(16)(27)(28)(29). Also consistent with our findings, most investigators have not identified a relationship between preexisting medical conditions and AFIB (1,13,14,18,24,25,27,28,(30)(31)(32).…”

supporting

confidence: 82%

“…In stepwise regression analysis, age was the most powerful predictor for AFIB, followed by right coronary artery stenosis. Conversely, Zaman et al (29) did not find a significant relationship between AFIB and right coronary artery stenosis. In our study, we also noted that AFIB prevalence significantly increased as the number of bypasses increased.…”

Section: Perioperative Predictive Characteristicsmentioning

confidence: 95%

“…The usual onset of AFIB is 2-4 days after surgery (5,11,28,29,32,38,41), thus it would be expected that AFIB onset occurred on the ward. Eleven subjects (4.6% of AFIB group) were readmitted to the ICU, compared with only 1 NAFIB subject (0.2% of NAFIB).…”

Section: Losmentioning

confidence: 99%

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Predictors and impact of atrial fibrillation after isolated coronary artery bypass grafting

Hravnak

Hoffman

Saul

et al. 2002

Critical Care Medicine

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Objective-Although an extensive number of studies have attempted to identify predictors of new-onset atrial fibrillation (AFIB) after coronary artery bypass grafting (CABG), a strong predictive model does not exist. Prior studies have included patients recruited from multiple centers with variant AFIB prevalence rates and those who underwent CABG in combination with other surgical procedures. Also, most studies have focused on pre-and perioperative characteristics, with less attention given to the initial postoperative period. The purpose of this study was to comprehensively examine pre-, peri-, and postoperative characteristics that might predict new-onset AFIB in a large sample of patients undergoing isolated CABG in a single medical center, utilizing data readily available to clinicians in electronic data repositories. In addition, length of stay and selected postoperative complications and disposition were compared in patients with AFIB and no AFIB. Design-Retrospective, comparative survey.Setting-University-affiliated tertiary care hospital.Patients-Patients with new-onset AFIB who underwent isolated standard CABG or minimally invasive direct vision coronary artery bypass were identified from an electronic clinical data repository. Interventions-None.Measurements and Main Results-The prevalence of AFIB in the total sample (n = 814) was 31.9%. Predictors of AFIB included age (p = .0004), number of vessels bypassed (p = .013), vessel location (diagonal [p < .003] or posterior descending artery [p < .001]), and net fluid balance on the operative day (p = .015). Forward stepwise regression analysis produced a model that correctly predicted AFIB in only 24% of cases, with age (14%) and body surface area (9%) providing the most prediction. The incidence of embolic stroke was higher in AFIB (n = 8) vs. no AFIB (n = 4) patients, but stroke preceded AFIB onset in seven of eight cases. Subjects with AFIB had a longer stay (p = .0004), more intensive care unit readmissions (p = .0004), and required more assistance at hospital discharge (p = .017).Conclusions-Despite attempts to examine comprehensively predictors of new-onset AFIB, we were unable to identify a robust predictive model. Our findings, in combination with prior work, imply that it may not be feasible to predict the development of new-onset AFIB after CABG using data readily available to the bedside clinician. In this sample, stroke was uncommon and, when it occurred, preceded AFIB in all but one case. As anticipated, AFIB increased length of stay, and patients with this complication required more assistance at discharge. Atrial fibrillation (AFIB) is the most common complication after coronary artery bypass grafting (CABG), with an incidence ranging from 5% to 40% (1-5). Although post-CABG AFIB is not associated with a significant increase in mortality (6), it has been noted to result in increased morbidity related to postoperative stroke (7,8), hemodynamic compromise (9), ventricular dysrhythmias (10), and iatrogenic complications associated with...

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confidence: 82%

Section: Perioperative Predictive Characteristicsmentioning

confidence: 95%

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Predictors and impact of atrial fibrillation after isolated coronary artery bypass grafting

Hravnak

Hoffman

Saul

et al. 2002

Critical Care Medicine

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“…Similar observational studies have shown mean serum magnesium levels to be significantly lower in patients who develop postoperative atrial fibrillation (AF) after CABG. 14,23 However, there are conflicting views with respect to a causal Although analysis of several studies seems to highlight an association between hypomagnesaemia and postoperative AF, the review failed to show significant efficacy of magnesium therapy in AF prevention after CABG. The inconclusive findings of these trials were partly due to limitations in methodology but most probably reflect the poor correlation between serum magnesium and intracellular (especially intra-atrial) magnesium levels.…”

Section: Discussionmentioning

confidence: 99%

“…They have demonstrated a significant fall in serum magnesium levels in patients undergoing cardiac procedures such as coronary artery bypass grafting (CABG), resulting in adverse cardiac and non-cardiac outcomes among hypomagnesaemic patients. [14][15][16] The mechanism behind this process is not fully understood. One mechanism proposed is that of haemodilution with prime fluid in the extracorporeal circuit in addition to intravenous fluid replacement.…”

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confidence: 99%

The incidence of hypomagnesaemia following abdominal aortic aneurysm surgery

Jolly

Faulconer

McEwan

et al. 2015

annals

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INTRODUCTION Magnesium is important for cardiac function. Hypomagnesaemia is associated with a higher incidence of arrhythmias and poorer outcomes in cardiac surgery. No studies have investigated the incidence or impact of postoperative hypomagnesaemia after abdominal aortic aneurysm (AAA) surgery. We aim to assess the incidence of hypomagnesaemia after AAA repair in our population. METHODS Retrospective analysis was performed of patients who underwent elective AAA surgery at a single vascular centre. The last 110 patients undergoing open or endovascular AAA repair were identified. The hospital pathology system was used to identify the immediate postoperative serum magnesium levels as well as patient demographics and admission details. Hypomagnesaemia was defined as serum magnesium of <0.7mmol/l. RESULTS A total of 211 patients were studied and there were 3 deaths. Of the patients included, 101 underwent open elective AAA repair and 110 underwent endovascular repair. In the elective open repair group, 73 patients (73%) were hypomagnesaemic. In the endovascular repair group, 35 (32%) had hypomagnesaemia. A t-test showed a statistically significant difference in hypomagnesaemia between the open and endovascular groups (p<0.001). CONCLUSIONS AAA surgery is associated with a high incidence of postoperative hypomagnesaemia, which is significantly greater among open repair patients. This is likely to have an effect on cardiac activity and lead to cardiac complications such as arrhythmias and poorer postoperative outcomes, especially in the open AAA repair subgroup. This stresses the importance of serum magnesium and cardiac monitoring in the postoperative phase. A prospective study is proposed to further investigate these findings, and their potential implications on perioperative morbidity and mortality.

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Electrocardiographic and Hemodynamic Effects of a Multicomponent Dietary Supplement Containing Ephedra and Caffeine

McBride¹,

Karapanos²,

Krudysz³

et al. 2004

JAMA

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Context Metabolife 356, a multicomponent dietary supplement containing ephedra and caffeine (DSEC) in addition to several other components, is the top-selling dietary weight loss supplement. Given its common use, anecdotal reports of cardiovascular and cerebrovascular adverse events, and paucity of safety data, further research with this DSEC was warranted. Objective To determine the impact of the DSEC on corrected QT (QTc) interval duration and systolic blood pressure (SBP). Design Randomized, double-blind, placebo-controlled, crossover study conducted from January to May 2003.

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The role of signal averaged P wave duration and serum magnesium as a combined predictor of atrial fibrillation after elective coronary artery bypass surgery.

Cited by 90 publications

References 29 publications

Predictors and impact of atrial fibrillation after isolated coronary artery bypass grafting

Predictors and impact of atrial fibrillation after isolated coronary artery bypass grafting

The incidence of hypomagnesaemia following abdominal aortic aneurysm surgery

Electrocardiographic and Hemodynamic Effects of a Multicomponent Dietary Supplement Containing Ephedra and Caffeine

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