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Atrial fibrillation after beating heart surgery

      Abstract

      Postoperative atrial fibrillation (AF) is a frequent adverse event after coronary artery bypass grafting (CABG) and may negatively affect the early clinical outcome. We sought to investigate the risk factors, prevalence, and prognostic implications of postoperative AF in patients submitted to CABG without cardiopulmonary bypass (off-pump). The study population comprised 969 patients, 645 men (67%) and 324 women (33%) who had off-pump CABG at the Washington Hospital Center from January 1987 to May 1999. Preoperative AF patients were excluded (n = 15). Two hundred six patients (age 69 ± 10 years, 137 men [66%]) developed AF, whereas 763 patients (age 61 ± 12 years, 508 men [67%]) did not. Predictors of AF included age >75 years (odds ratio [OR] 3.0, 95% confidence interval [CI] 1.9 to 4.5; p <0.001), history of stroke (OR 2.1, CI 1.2 to 3.7; p = 0.007), postoperative pleural effusion requiring thoracentesis (OR 3.2, CI 1.0 to 9.4; p = 0.03), and postoperative pulmonary edema (OR 5.1, CI 1.2 to 21; p = 0.02). Minimally invasive direct CABG was associated with a lower incidence of AF (OR 0.4, CI 0.3 to 0.7; p <0.001). AF was associated with a prolonged postoperative hospital stay (9 ± 6 days AF vs 6 ± 5 days no AF, p <0.001). In-hospital mortality was significantly higher in AF patients (3% AF vs 1% no AF, p = 0.009). Patients with persistent AF had a higher postoperative in-hospital stroke rate than patients without persistent AF (9% vs 0.6%, p <0.001). AF after beating heart surgery is associated with a higher in-hospital morbidity, mortality, and prolonged hospital stay. A minimally invasive surgical approach (minimally invasive direct CABG) is associated with a lower risk of AF.
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      References

        • Mathew J.P.
        • Parks R.
        • Savino J.S.
        • Friedman A.S.
        • Koch C.
        • Mangano D.T.
        • Browner W.S.
        Atrial fibrillation following coronary artery bypass graft surgery. Predictors, outcome, and resource utilization.
        JAMA. 1996; 276: 300-306
        • Lauer M.S.
        • Eagle K.A.
        • Buckley M.J.
        • DeSanctis R.W.
        Atrial fibrillation following coronary artery bypass surgery.
        Prog Cardiovasc Dis. 1989; 31: 367-378
        • Creswell L.L.
        • Schuessler R.B.
        • Rosenbloom M.
        • Cox J.L.
        Hazards of postoperative atrial arrhythmias.
        Ann Thorac Surg. 1993; 56: 539-549
        • Rubin D.A.
        • Nieminski K.E.
        • Reed G.E.
        • Herman M.V.
        Predictors, prevention, and long-term prognosis of atrial fibrillation after coronary artery bypass graft operations.
        J Thorac Cardiovasc Surg. 1987; 94: 331-335
        • Crosby L.H.
        • Pifalo W.B.
        • Woll K.R.
        • Burkholder J.A.
        Risk factors for atrial fibrillation after coronary artery bypass grafting.
        Am J Cardiol. 1990; 66: 1520-1522
        • Leitch J.W.
        • Thompson D.
        • Baird D.K.
        • Harris P.J.
        The importance of age as a predictor of atrial fibrillation and flutter after coronary artery bypass grafting.
        J Thorac Cardiovasc Surg. 1990; 100: 338-342
        • Aranki S.F.
        • Shaw D.P.
        • Adams D.H.
        • Rizzo R.J.
        • Couper G.S.
        • VanderVliet M.
        • Collins Jr, J.J.
        • Cohn L.H.
        • Burstin H.R.
        Predictors of atrial fibrillation after coronary artery surgery. Current trends and impact on hospital resources.
        Circulation. 1996; 94: 390-397
        • Asamura H.
        • Naruke T.
        • Tsuchiya R.
        • Goya T.
        • Kondo H.
        • Suemasu K.
        What are the risk factors for arrhythmias after thoracic operations? A retrospective multivariate analysis of 267 consecutive thoracic operations.
        J Thorac Cardiovasc Surg. 1993; 106: 1104-1110
        • Allen K.B.
        • Matheny R.G.
        • Robison R.J.
        • Heimansohn D.A.
        • Shaar C.J.
        Minimally invasive versus conventional reoperative coronary artery bypass.
        Ann Thorac Surg. 1997; 64: 616-622
      1. Stamou SC, Dangas G, Dullum MKC, Pfister AJ, Boyce SW, Bafi AS, Garcia JM, Corso PJ. Beating heart surgery in octogenarians: perioperative outcomes and comparison with younger age groups. Ann Thorac Surg; in press.

      2. Stamou SC, Pfister AJ, Dangas G, Dullum MKC, Boyce SW, Bafi AS, Garcia JM, Corso PJ. Beating heart versus conventional single vessel reoperative coronary artery bypass surgery. Ann Thorac Surg; in press

        • Almassi G.H.
        • Schowalter T.
        • Nicolosi A.C.
        • Aggarwal A.
        • Moritz T.E.
        • Henderson W.G.
        • Tarazi R.
        • Shroyer A.L.
        • Sethi G.K.
        • Grover F.L.
        • Hammermeister K.E.
        Atrial fibrillation after cardiac surgery.
        Ann Surg. 1997; 226: 501-513
        • Benjamin E.J.
        • Wolf P.A.
        • D’Agostino R.B.
        • Silbershatz H.
        • Kannel W.B.
        • Levy D.
        Impact of atrial fibrillation on the risk of death.
        Circulation. 1998; 98: 946-952
        • Hohnloser S.H.
        Can we predict atrial fibrillation after coronary surgery and why should we?.
        Eur Heart J. 1998; 19: 684-685
        • Cox J.L.
        A perspective of postoperative atrial fibrillation in cardiac operations.
        Ann Thorac Surg. 1993; 56: 405-409
        • Elvan A.
        • Huang X.D.
        • Pressler M.
        • Zipes D.P.
        Radiofrequency catheter ablation of the atria eliminates pacing-induced sustained atrial fibrillation and reduces connexin 43 in dogs.
        Circulation. 1997; 96: 1675-1685
        • Cohn W.E.
        • Sirois C.A.
        • Johnson R.G.
        Atrial fibrillation after minimally invasive coronary artery bypass grafting.
        J Thorac Cadiovasc Surg. 1999; 117: 298-301
        • Abreu J.E.
        • Reilly J.
        • Salzano R.P.
        • Khachane V.B.
        • Jekel J.F.
        • Clyne C.A.
        Comparison of frequencies of atrial fibrillation after coronary artery bypass grafting with and without the use of cardiopulmonary bypass.
        Am J Cardiol. 1999; 83: 775-776
        • Lie J.T.
        • Hammond P.I.
        Pathology of the senescent heart.
        Mayo Clin Proc. 1988; 63: 552-564
        • Taylor G.J.
        • Mikell F.L.
        • Moses W.
        • Dove J.T.
        • Katholi R.E.
        • Malik S.A.
        • Markwell S.J.
        • Korsmeyer C.
        • Schneider J.A.
        • Wellons H.A.
        Determinants of hospital charges for coronary artery bypass surgery.
        Am J Cardiol. 1990; 65: 309-313