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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Article Info
Publication History
Published online: August 16, 2004
Accepted:
January 12,
2000
Received in revised form:
January 12,
2000
Received:
November 11,
1999
Identification
Copyright
© 2000 Excerpta Medica Inc. Published by Elsevier Inc. All rights reserved.
