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Mangi AR, Zia K, Ali TA, Karim M, Fatimi SH. Postoperative Atrial Fibrillation Among Patients Undergoing Isolated Coronary Artery Bypass Grafting. Cureus 2019; 11:e4333. [PMID: 31186998 PMCID: PMC6541155 DOI: 10.7759/cureus.4333] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 03/27/2019] [Indexed: 11/05/2022] Open
Abstract
Introduction Postoperative atrial fibrillation (AF) is the commonest of all the known cardiac arrhythmias after cardiac surgery. The postoperative AF has both short- and long-term adverse impacts on patients, like prolonged intensive care unit (ICU) stay, increased frequency of reoperations, myocardial infarction, increased use of inotropes, and intra-aortic balloon pump (IABP). There is a paucity of data regarding the postoperative AF after isolated coronary artery bypass grafting (CABG) and its risk factors in our geographic location. Therefore, the aim of this study was to determine the frequency of postoperative atrial fibrillation among patients undergoing isolated CABG at a tertiary care hospital of Karachi, Pakistan. Methods This prospective observational study was conducted on 163 consecutively selected patients undergoing first time isolated CABG at the Department of Cardiothoracic Surgery, Aga Khan University Hospital, Karachi. Patients with redo-sternotomy, preoperative atrial fibrillation and with other cardiac pathology were excluded from the study. Postoperative AF was defined in the patients with postoperative 12-lead electrocardiographic (ECG) finding of absence of P waves, replaced by unorganized electrical activity and irregular R-R intervals. Data analysis was carried out using IBM SPSS Statistics for Windows, Version 21.0 (IBM Corp., Armonk, NY, USA). Results A total of 163 patients were enrolled with the mean age of 58.66 ± 9.77 years ranging between 40 and 85 years with male predominance of 81% (132). The most common comorbidity was hypertension in about 68.1% (111), followed by diabetes mellitus in 54.6% (89) patients. Postoperative AF was observed in 42 (25.8%) patients. Most of the patients who developed postoperative AF, were overweight with mean body mass index (BMI) of 27.04 ± 4.85 kg/m2, 76.2% (32) had a history of hypertension, diabetes mellitus was associated with 33.3% (14) patients with postoperative AF and 50.0% (21) of them were smokers. Distribution of coronary artery disease in patients with postoperative AF was observed as three vessels coronary artery disease (3VCAD) in 83.3% (35), two-vessel coronary artery disease (2VCAD) was present in 7.1% (three), and rest of 9.5% (four) patients had single-vessel coronary artery disease (SVCAD). Conclusion The frequency of postoperative atrial fibrillation in our study was found to be 25.9% which is comparable to world literature. An important finding that comes through this study is a younger population undergoing CABG, which raises the possibility of early manifestation of ischemic heart disease in our region. This, however, needs further investigation. We were unable to point out the factors predictive of postoperative AF; studies with larger sample size would help in that regard.
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Affiliation(s)
- Ali R Mangi
- Cardiac Surgery, National Institute of Cardiovascular Diseases (NICVD), Karachi, PAK
| | - Kashif Zia
- Cardiac Surgery, National Institute of Cardiovascular Diseases (NICVD), Karachi, PAK
| | - Taimur A Ali
- Cardiac Surgery, National Institute of Cardiovascular Diseases (NICVD), Karachi, PAK
| | - Musa Karim
- Miscellaneous, National Institute of Cardiovascular Diseases (NICVD), Karachi, PAK
| | - Saulat H Fatimi
- Cardiothoracic Surgery, The Aga Khan University, Karachi, PAK
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Farouk Musa A, Quan CZ, Xin LZ, Soni T, Dillon J, Hay YK, Nordin RB. A retrospective study on atrial fibrillation after coronary artery bypass grafting surgery at The National Heart Institute, Kuala Lumpur. F1000Res 2018; 7:164. [PMID: 30254739 PMCID: PMC6127737 DOI: 10.12688/f1000research.13244.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/01/2018] [Indexed: 01/21/2023] Open
Abstract
Background: Atrial fibrillation (AF) is common after cardiac surgery and has been associated with poor outcome and increased resource utilization. The main objective of this study is to determine the incidence of POAF in Malaysia and identify the predictors of developing POAF. The secondary outcome of this study would be to investigate the difference in mortality and morbidity rates and the duration of intensive care unit (ICU), high dependency unit (HDU) and hospital stay between the two. Methods: This is a retrospective single-center, cross sectional study conducted at the National Heart Institute, Malaysia. Medical records of 637 who underwent coronary artery bypass grafting (CABG) surgery in 2015 were accrued. Pre-operative, operative and post-operative information were subsequently collected on a pre-formulated data collection sheet. Data were then analyzed using IBM SPSS v23. Results: The incidence of POAF in our study stands at 28.7% with a mean onset of 45±33 hours post operatively. Variables with independent association with POAF include advancing age, Indian population, history of chronic kidney disease, left ventricular ejection fraction and beta-blocker treatment. The mortality rate is significantly higher statistically ( p < 0.05), and similarly the incidence of stroke. The incidence of other post-operative complications was also significantly higher statistically. The duration of ICU, HDU and hospital stays were statistically longer ( p < 0.001) with higher rates of ICU readmissions and reintubations seen. Conclusion: We conclude that the incidence of POAF in Malaysia is comparable to the figures in Western countries, making POAF one of the most commonly encountered condition after CABG with similar higher rates of mortality, poor outcomes and longer duration of stay, and therefore increased cost of care. Strategies to reduce the incidence of AF after cardiac surgery should favorably affect surgical outcomes and reduce utilization of resources and thus lower cost of care.
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Affiliation(s)
- Ahmad Farouk Musa
- School of Medicine and Health Sciences, Monash University Malaysia, Subang Jaya, Malaysia
| | - Chou Zhao Quan
- School of Medicine and Health Sciences, Monash University Malaysia, Subang Jaya, Malaysia
| | - Low Zheng Xin
- School of Medicine and Health Sciences, Monash University Malaysia, Subang Jaya, Malaysia
| | - Trived Soni
- School of Medicine and Health Sciences, Monash University Malaysia, Subang Jaya, Malaysia
| | - Jeswant Dillon
- Department of Cardiothoracic Surgery, National Heart Institute, Kuala Lumpur, Malaysia
| | - Yuen Kah Hay
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
| | - Rusli Bin Nordin
- School of Medicine and Health Sciences, Monash University Malaysia, Subang Jaya, Malaysia
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Farouk Musa A, Quan CZ, Xin LZ, Soni T, Dillon J, Hay YK, Nordin RB. A retrospective study on atrial fibrillation after coronary artery bypass grafting surgery at The National Heart Institute, Kuala Lumpur. F1000Res 2018; 7:164. [PMID: 30254739 PMCID: PMC6127737 DOI: 10.12688/f1000research.13244.2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/19/2018] [Indexed: 11/30/2022] Open
Abstract
Background: Atrial fibrillation (AF) is common after cardiac surgery and has been associated with poor outcome and increased resource utilization. The main objective of this study is to determine the incidence of POAF in Malaysia and identify the predictors of developing POAF. The secondary outcome of this study would be to investigate the difference in mortality and morbidity rates and the duration of intensive care unit (ICU), high dependency unit (HDU) and hospital stay between the two. Methods: This is a retrospective single-center, cross sectional study conducted at the National Heart Institute, Malaysia. Medical records of 637 who underwent coronary artery bypass grafting (CABG) surgery in 2015 were accrued. Pre-operative, operative and post-operative information were subsequently collected on a pre-formulated data collection sheet. Data were then analyzed using IBM SPSS v23. Results: The incidence of POAF in our study stands at 28.7% with a mean onset of 45±33 hours post operatively. Variables with independent association with POAF include advancing age, Indian population, history of chronic kidney disease, left ventricular ejection fraction and beta-blocker treatment. The mortality rate is significantly higher statistically ( p < 0.05), and similarly the incidence of stroke. The incidence of other post-operative complications was also significantly higher statistically. The duration of ICU, HDU and hospital stays were statistically longer ( p < 0.001) with higher rates of ICU readmissions and reintubations seen. Conclusion: We conclude that the incidence of POAF in Malaysia is comparable to the figures in Western countries, making POAF one of the most commonly encountered condition after CABG with similar higher rates of mortality, poor outcomes and longer duration of stay, and therefore increased cost of care. Strategies to reduce the incidence of AF after cardiac surgery should favorably affect surgical outcomes and reduce utilization of resources and thus lower cost of care.
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Affiliation(s)
- Ahmad Farouk Musa
- School of Medicine and Health Sciences, Monash University Malaysia, Subang Jaya, Malaysia
| | - Chou Zhao Quan
- School of Medicine and Health Sciences, Monash University Malaysia, Subang Jaya, Malaysia
| | - Low Zheng Xin
- School of Medicine and Health Sciences, Monash University Malaysia, Subang Jaya, Malaysia
| | - Trived Soni
- School of Medicine and Health Sciences, Monash University Malaysia, Subang Jaya, Malaysia
| | - Jeswant Dillon
- Department of Cardiothoracic Surgery, National Heart Institute, Kuala Lumpur, Malaysia
| | - Yuen Kah Hay
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
| | - Rusli Bin Nordin
- School of Medicine and Health Sciences, Monash University Malaysia, Subang Jaya, Malaysia
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Dave S, Nirgude A, Gujjar P, Sharma R. Incidence and risk factors for development of atrial fibrillation after cardiac surgery under cardiopulmonary bypass. Indian J Anaesth 2018; 62:887-891. [PMID: 30532326 PMCID: PMC6236789 DOI: 10.4103/ija.ija_6_18] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background and Aims Atrial fibrillation (AF) is a common postoperative complication after cardiac surgery due to multifactorial causes. The aim of this study was to evaluate the incidence and risk factors of postoperative atrial fibrillation (POAF) after cardiac surgery under cardiopulmonary bypass (CPB). Methods A total of 150 adult patients undergoing coronary artery bypass graft (CABG) surgery and valvular surgeries were included. They were evaluated with respect to preoperative risk factors [age, use of β-blockers, left ventricular ejection fraction (LVEF), previous myocardial infarction (MI) and diabetes], intraoperative factors (CABG or valvular surgery, duration of CPB and aortic cross clamp time) and postoperative factors (duration of inotropic support and ventilatory support). Outcome measure was POAF after cardiac surgery under CPB. Postoperative intensive care unit and hospital stay and mortality were also studied. Results Of the patients who developed POAF, 50% were less than 60 years, 50.6% were diabetics, 50.7% had prior MI,19.7% had LVEF <40%, 82.6%were not on β-blockers, 66.7% had aortic cross clamp time >60 min and 60% had surgery with CPB time >100 min. About 38.8% underwent CABG and 43.1%underwent valvular surgery. There was a positive association with LVEF <40%, prior MI, post-bypass inotropic support greater than 10 min and ventilatory support more than 24 h with the development of POAF. Conclusion The incidence of POAF after cardiac surgery was 40.7%. Preoperative LVEF <0.4, prior MI, CPB time >100 minand extended ventilation for >24 h were significantly associated with POAF.
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Affiliation(s)
- Sona Dave
- Department of Anaesthesiology, Topiwala National Medical College and BYL Nair Charitable Hospital, Mumbai, Maharashtra, India
| | - Anand Nirgude
- Department of Anaesthesiology, Topiwala National Medical College and BYL Nair Charitable Hospital, Mumbai, Maharashtra, India
| | - Pinakin Gujjar
- Department of Anaesthesiology, Topiwala National Medical College and BYL Nair Charitable Hospital, Mumbai, Maharashtra, India
| | - Ritika Sharma
- Department of Anaesthesiology, Topiwala National Medical College and BYL Nair Charitable Hospital, Mumbai, Maharashtra, India
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The Effects of Diabetes Mellitus in Patients Undergoing Off-Pump Coronary Artery Bypass Grafting. BIOMED RESEARCH INTERNATIONAL 2016; 2016:4967275. [PMID: 27777946 PMCID: PMC5061928 DOI: 10.1155/2016/4967275] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 08/02/2016] [Accepted: 09/06/2016] [Indexed: 11/18/2022]
Abstract
Objective. To investigate the effects of diabetes mellitus (DM) in patients undergoing off-pump coronary artery bypass grafting (OPCAB). Method. A total of 728 patients with DM and 1380 patients without DM who underwent OPCAB treatment from March 2012 to April 2015 were reviewed. The effects of DM on intraoperative variables and postoperative complications were determined using propensity score analysis. Results. Two well-matched subgroups were selected using propensity score analysis (DM = 728, no-DM = 728) to compare the perioperative outcome. The duration of the ICU stay, in hours (55.2 ± 53.0 versus 49.29 ± 51.30, P < 0.05), postoperative new-onset atrial fibrillation (20.9% versus 14.97%, P < 0.05), and postoperative infection (9.2% versus 4.67%, P < 0.05) were greater in DM patients, as indicated by univariate analysis. Conclusion. OPCAB was found to be effective in DM patients, but postoperative infection and postoperative new-onset atrial fibrillation were found to be more likely to occur in DM patients than in other patients. DM was found to be a powerful risk factor for postoperative infection and postoperative new-onset atrial fibrillation.
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Xiong F, Yin Y, Dubé B, Pagé P, Vinet A. Electrophysiological changes preceding the onset of atrial fibrillation after coronary bypass grafting surgery. PLoS One 2014; 9:e107919. [PMID: 25247814 PMCID: PMC4172567 DOI: 10.1371/journal.pone.0107919] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Accepted: 08/24/2014] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND The incidence of Post-CABG atrial fibrillation (AF) lies between 25% and 40%. It worsens morbidity and raises post-operative costs. Detection of incoming AF soon enough for prophylactic intervention would be helpful. The study is to investigate the electrophysiological changes preceding the onset of AF and their relationship to the preoperative risk. METHODS AND RESULTS Patients were recorded continuously for the first four days after coronary artery bypass grafting surgery (CABG) with three unipolar electrodes sutured to the atria (AEG). The patients experiencing an AF lasting more than 10 minutes were selected and the two hours before the onset were analyzed. Four variables were found to show significant changes in the two hours prior to the first prolonged AF: increasing rate of premature atrial activation, increasing incidence of short transient arrhythmias, acceleration of heart rate, and rise of low frequency content of heart rate. The main contrast was between the first and last hour before AF onset. Preoperative risk was not predictive of the onset time of AF and did not correlate with the amplitude of changes prior to AF. CONCLUSIONS Post-CABG AF were preceded by electrophysiological changes occurring in the last hour before the onset of the arrhythmia, whereas none of these changes was found to occur in all AF patients. The risk was a weighted sum of factors related to the density of premature activations and the state of atrial substrate reflected by the sinus rhythm and its frequency content prior to AF. Preoperative risk score seems unhelpful in setting a detection threshold for the AF onset.
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Affiliation(s)
- Feng Xiong
- Research Center, Hôpital du Sacré-Cœur de Montréal, Université de Montréal, Montréal, Canada
- Montréal Heart Institute, Université de Montréal, Montréal, Canada
| | - Yalin Yin
- Research Center, Hôpital du Sacré-Cœur de Montréal, Université de Montréal, Montréal, Canada
| | - Bruno Dubé
- Research Center, Hôpital du Sacré-Cœur de Montréal, Université de Montréal, Montréal, Canada
- Biomedical Engineering Institute, Université de Montréal, Montréal, Canada
| | - Pierre Pagé
- Research Center, Hôpital du Sacré-Cœur de Montréal, Université de Montréal, Montréal, Canada
- Montréal Heart Institute, Université de Montréal, Montréal, Canada
- Department of Surgery, Université de Montréal, Montréal, Canada
| | - Alain Vinet
- Research Center, Hôpital du Sacré-Cœur de Montréal, Université de Montréal, Montréal, Canada
- Biomedical Engineering Institute, Université de Montréal, Montréal, Canada
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Tadic M, Ivanovic B, Zivkovic N. Predictors of atrial fibrillation following coronary artery bypass surgery. Med Sci Monit 2011; 17:CR48-55. [PMID: 21169910 PMCID: PMC3524673 DOI: 10.12659/msm.881329] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2010] [Accepted: 07/29/2010] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND New-onset atrial fibrillation is the most common form of rhythm disturbance following coronary artery bypass grafting surgery (CABG). It is still unclear which factors have a significant impact on its occurrence after this procedure. The aim of this study was to evaluate clinical predictors of postoperative atrial fibrillation (POAF) after myocardial revascularization. MATERIAL/METHODS We performed a retrospective analysis of 322 patients who underwent the first CABG operation without baseline atrial fibrillation. All subjects underwent laboratory blood tests, echocardiography and selective coronarography with ventriculography. Patients were continuously electrocardiographically monitored during the first 48-72 h after the operation for the occurrence of POAF. RESULTS POAF was diagnosed in 72 (22.4%) of the patients. Multivariate logistic regression analysis was used to identify the following independent clinical predictors of POAF: age≥65 years (OR 1.78; 95%CI: 1.06-2.76; p=0.043), hypertension (OR 1.97; 95%CI: 1.15-3.21; p=0.018), diabetes mellitus (OR 2.09; 95% CI: 1.31-5.33; p=0.010), obesity (OR 1.51; 95%CI: 1.03-3.87; p=0.031), hypercholesterolemia (OR 2.17, 95%CI: 1.05-4.25; p=0.027), leukocytosis (OR 2.32, 95%CI: 1.45-5.24; p=0.037), and left ventricular segmental kinetic disturbances (OR 3.01; 95%CI: 1.65-4.61, p<0.001). CONCLUSIONS This study demonstrates that advanced age, hypertension, diabetes, obesity, hypercholesterolemia, leukocytosis, and segmental kinetic disturbances of the left ventricle are powerful risk factors for the occurrence of POAF.
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Affiliation(s)
- Marijana Tadic
- Clinical Centre of Serbia, Clinic for Cardiology, Belgrade, Serbia.
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Banach M, Rysz J, Drozdz JA, Okonski P, Misztal M, Barylski M, Irzmanski R, Zaslonka J. Risk factors of atrial fibrillation following coronary artery bypass grafting: a preliminary report. Circ J 2006; 70:438-41. [PMID: 16565561 DOI: 10.1253/circj.70.438] [Citation(s) in RCA: 92] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND To evaluate the risks factors of atrial fibrillation (AF) following coronary artery bypass grafting (CABG). METHODS AND RESULTS Twelve hundred patients subjected to CABG were included. Postoperative AF developed in 278 patients (23.2%). Statistical analysis identified 5 independent predictors of AF: advanced age, history of supraventricular arrhythmias, preoperative heart failure, operation with standard CABG technique and repeated revascularization. CONCLUSIONS Postoperative AF caused a significant increase in mortality and hospitalization length. There were 4 independent risk factors of postoperative AF. Administration of beta-blockers and the OPCAB (off-pump CABG) operating technique were identified as protective factors.
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Affiliation(s)
- Maciej Banach
- Department of Cardiac Surgery, University Hospital No 3, Medical University of Lodz, University Hospital, Poland.
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