Usefulness of atrial fibrillation as a predictor of stroke after isolated coronary artery bypass grafting

Taylor, George J.; Malik, Shezad A.; Colliver, Jerry A.; Dove, James T.; Moses, H.Weston; Mikell, Frank L.; Batchelder, John E.; Schneider, Joel A.; Wellons, Harry A.

doi:10.1016/0002-9149(87)91045-9

Cited by 168 publications

(53 citation statements)

References 20 publications

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“…Because of their importance in identifying risk for postoperative AF in other reports, the duration of aortic cross clamping during surgery and preoperative use of ␤-adrenergic receptor blocking drugs were included in the multivariate analysis, along with the number of coronary bypass grafts performed, duration of cardiopulmonary bypass, preoperative hypertension, lung disease, and medication use. [1][2][3][4] A backward, stepwise elimination process was used; ie, variables with the largest nonsignificant P values were eliminated until all values in the model were significant. Receiver operating characteristic curves were constructed to evaluate the predictive accuracy of the multivariate model.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4][5][6] The strong association of postoperative AF with advancing age and the increasing proportion of cardiac surgical patients who are elderly suggest that the frequency of postoperative AF and associated complications is likely to increase. 1,3,4,7 Electrophysiological mapping studies in patients indicate that the mechanism for AF is reentry, but the pathophysiology of AF after CABG surgery is not entirely clear and does not provide an explanation for why some individuals develop this arrhythmia while others exposed to similar surgery remain in sinus rhythm.…”

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confidence: 99%

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RR Interval Dynamics Before Atrial Fibrillation in Patients After Coronary Artery Bypass Graft Surgery

et al. 1998

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Background-Atrial fibrillation/flutter (AF) is a frequent complication of coronary artery bypass graft surgery (CABG) that leads to increased costs and morbidity. We hypothesized that heart rate variability (HRV), an indicator of cardiac sympathovagal balance, is altered before the onset of postoperative AF. Because nonlinear methods of HRV analysis provide information about heart rate dynamics not evident from usual HRV measures, we also hypothesized that approximate entropy (ApEn), a nonlinear measure of HRV, might have predictive value. Methods and Results-Analysis of HRV was performed in 3 sequential 20-minute intervals preceding the onset of postoperative AF (24 episodes in 18 patients). These data were compared with corresponding intervals in 18 sex-and age-matched postoperative control subjects who did not develop AF. Patients had left ventricular ejection fractions Ͼ45% before surgery and were not receiving ␤-blockers during ambulatory ECG monitoring after surgery. Logistic regression demonstrated that on the basis of averaged values for the three 20-minute intervals, increased heart rate and decreased ApEn were independently associated with AF. Heart rate dynamics before AF was associated with either lower (nϭ19) or higher (nϭ5) RR interval variation by traditional measures of HRV or quantitative Poincaré analysis, suggesting the possibility of divergent autonomic conditions before AF onset. Conclusions-In the hour before AF after CABG surgery, higher heart rate and lower heart rate complexity compared with values in control patients were independent predictors of AF. Decreased ApEn occurs in patients with either increased or decreased HRV by traditional measures and may provide a useful tool for risk stratification or investigation of mechanisms. (Circulation. 1998;98:429-434.)

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

RR Interval Dynamics Before Atrial Fibrillation in Patients After Coronary Artery Bypass Graft Surgery

et al. 1998

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“…[62][63][64] Because of the low rate of stroke after heart surgery, no trial of sufficient statistical power can realistically be done. Meta-analysis of available data (limited to 2877 randomized patients) provided no evidence of significant benefit against stroke.…”

Section: Strokementioning

confidence: 99%

Interventions on Prevention of Postoperative Atrial Fibrillation in Patients Undergoing Heart Surgery

et al. 2002

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Background-Postoperative atrial fibrillation (AF) is a common complication of cardiac surgery and has been associated with increased incidence of other complications and increased hospital length of stay (LOS). Prevention of AF is a reasonable clinical goal, and, consequently, many randomized trials have evaluated the effectiveness of pharmacological and nonpharmacological interventions for prevention of AF. To better understand the role of various prophylactic therapies against postoperative AF, a systematic review of evidence from randomized trials was performed. Methods and Results-Fifty-two randomized trials (controlled by placebo or routine treatment) of ␤-blockers, sotalol, amiodarone, or pacing were identified by systematic literature search.

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“…On the other hand, we found a significant higher rate of incidence of postoperative cerebrovascular events (delirium, transient ischemic attacks and strokes) in the CAVR group (4.1% vs. 1.6%, p=0.03). This might be attributed to the well-known fact that the risk of postoperative stroke has been shown to be nearly threefold higher for patients with postoperative atrial fibrillation (Hogue & Hyder, 2000;Taylor et al, 1987), our study reported that the incidence of Atrial arrhythmias was significantly higher in the CAVR group before applying propensity matching (3.8% vs. 1.8%, p=0.002, respectively).…”

Section: Morbidity and Mortalitymentioning

confidence: 59%

015 * Propensity Score Analysis of Outcomes Following Minimally Invasive Versus Conventional Aortic Valve Replacement

Shehada

Voß

Elhmidi

et al. 2014

Interactive CardioVascular and Thoracic Surgery

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Usefulness of atrial fibrillation as a predictor of stroke after isolated coronary artery bypass grafting

Cited by 168 publications

References 20 publications

RR Interval Dynamics Before Atrial Fibrillation in Patients After Coronary Artery Bypass Graft Surgery

RR Interval Dynamics Before Atrial Fibrillation in Patients After Coronary Artery Bypass Graft Surgery

Interventions on Prevention of Postoperative Atrial Fibrillation in Patients Undergoing Heart Surgery

015 * Propensity Score Analysis of Outcomes Following Minimally Invasive Versus Conventional Aortic Valve Replacement

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