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Zhang RJZ, Yu XY, Wang J, Lv J, Zheng Y, Yu MH, Zang YR, Shi JW, Wang JH, Wang L, Liu ZG. A prediction model for new-onset atrial fibrillation following coronary artery bypass graft surgery: A multicenter retrospective study. Heliyon 2023; 9:e14656. [PMID: 37020944 PMCID: PMC10068116 DOI: 10.1016/j.heliyon.2023.e14656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 03/14/2023] [Accepted: 03/14/2023] [Indexed: 03/28/2023] Open
Abstract
Objective Developing and assessing a risk prediction model of postoperative atrial fibrillation (POAF) after coronary artery bypass grafting (CABG), and aims to provide a reference for the prediction and prevention. Design A retrospective case-control study. Setting Three major urban teaching and university hospitals and tertiary referral centers. Participants consecutive patients undergoing CABG. Interventions The study was retrospective and no interventions were administered to patients. Measurements and main results In the study, the overall new-onset POAF prevalence was approximately 28%. A prediction model for POAF with nine significant indicators was developed, and identified new predictors of POAF: left ventricular end diastolic diameter (LVEDD), intraoperative defibrillation, and intraoperative temporary pacing lead implantation. The model had good discrimination in both the derivation and validation cohorts, with the area under the receiver operating characteristic curves (AUCs) of 0.621 (95% CI = 0.602-0.640) and 0.616 (95% CI = 0.579-0.651), respectively, and showed good calibration. Compared with CHA2DS2-VASc, HATCH score, and the prediction model of POAF after CABG developed based on a small sample of clinical data from a single center in China, the model in this study had better discrimination. Conclusion We have developed and validated a new prediction model of POAF after CABG using multicenter data that can be used in the clinic for early identification of high-risk patients of POAF, and to help effectively prevent POAF in postoperative patients.
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Affiliation(s)
- Ren-Jian-Zhi Zhang
- Department of Cardiovascular Surgery, TEDA International Cardiovascular Hospital, Chinese Academy of Medical Sciences & Graduate School of Peking Union Medical College, Tianjin, 300457, China
| | - Xin-Yi Yu
- Department of Cardiovascular Surgery, TEDA International Cardiovascular Hospital, Chinese Academy of Medical Sciences & Graduate School of Peking Union Medical College, Tianjin, 300457, China
| | - Jing Wang
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 6913114, China
| | - Jian Lv
- Department of Cardiovascular Surgery, Nanyang Central Hospital, Nanyang, 473005, China
| | - Yan Zheng
- First School of Clinical Medicine, Lanzhou University, Lanzhou, 730013, China
| | - Ming-Huan Yu
- Department of Cardiovascular Surgery, TEDA International Cardiovascular Hospital, Chinese Academy of Medical Sciences & Graduate School of Peking Union Medical College, Tianjin, 300457, China
| | - Yi-Rui Zang
- Department of Cardiovascular Surgery, TEDA International Cardiovascular Hospital, Chinese Academy of Medical Sciences & Graduate School of Peking Union Medical College, Tianjin, 300457, China
| | - Jian-Wei Shi
- Department of Cardiovascular Surgery, TEDA International Cardiovascular Hospital, Chinese Academy of Medical Sciences & Graduate School of Peking Union Medical College, Tianjin, 300457, China
| | - Jia-Hui Wang
- Department of Cardiovascular Surgery, TEDA International Cardiovascular Hospital, Chinese Academy of Medical Sciences & Graduate School of Peking Union Medical College, Tianjin, 300457, China
| | - Li Wang
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 6913114, China
| | - Zhi-Gang Liu
- Department of Cardiovascular Surgery, TEDA International Cardiovascular Hospital, Chinese Academy of Medical Sciences & Graduate School of Peking Union Medical College, Tianjin, 300457, China
- Corresponding author.
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Rafaqat S, Rafaqat S, Khurshid H, Rafaqat S. Electrolyte’s imbalance role in atrial fibrillation: Pharmacological management. INTERNATIONAL JOURNAL OF ARRHYTHMIA 2022. [DOI: 10.1186/s42444-022-00065-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
AbstractThe contribution of the perpetuation of atrial fibrillation is caused by electrical remodeling in which calcium, sodium and potassium channels could refer to changes in the ion channel protein expression, development of fibrosis, gene transcription and ion channel redistribution. Calcium and magnesium could influence the risk of atrial fibrillation which is the leading cause of cardiac death, heart failure and ischemic stroke. The elevated serum concentration of calcium had a higher range of in-patient’s mortality, increased total cost of hospitalization and increased length of hospital stay as compared to those without hypercalcemia in atrial fibrillation patients. Moreover, chloride channels could affect homeostasis, atrial myocardial metabolism which may participate in the development of atrial fibrillation. Up to a 50% risk of incidence of AF are higher in which left ventricular hypertrophy, sudden cardiovascular death and overall mortality relate to a low serum magnesium level. Additionally, magnesium prevents the occurrence of AF after cardiac surgery, whereas greater levels of serum phosphorus in the large population-based study and the related calcium–phosphorus products were linked with a greater incidence of AF. Numerous clinical studies had shown the high preoperative risk of AF that is linked with lower serum potassium levels. The conventional risk factor of increased risk of new onset of AF events could independently link with high dietary sodium intake which enhances the fibrosis and inflammation in the atrium but the mechanism remains unknown. Many drugs were used to maintain the electrolyte imbalance in AF patients.
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Hizuka K, Kato T, Shiko Y, Kawasaki Y, Koyama K. Ionized Hypomagnesemia Is Associated With Increased Incidence of Postoperative Atrial Fibrillation After Esophageal Resection: A Retrospective Study. Cureus 2021; 13:e17105. [PMID: 34395148 PMCID: PMC8357411 DOI: 10.7759/cureus.17105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2021] [Indexed: 01/18/2023] Open
Abstract
Introduction: Postoperative atrial fibrillation (POAF) is common after surgery for esophageal cancer and may prolong hospitalization and elevate mortality. POAF and hypomagnesemia are linked, but this is based on studies showing an association of POAF with serum total magnesium (tMg). In contrast, the relationship of POAF with ionized magnesium (iMg), which has physiological activity, has not been examined. In this study, the association between hypomagnesemia and POAF was investigated retrospectively to examine iMg as a possible predictive factor for POAF. Methods: The subjects were 151 patients who underwent right transthoracoabdominal subtotal esophagectomy at Saitama Medical Center between January 2011 and December 2020. The incidence of POAF and predictive factors were examined retrospectively. Perioperative predictive factors were subjected to univariate analysis, and items with P<0.1 were then included in multivariate analysis, along with five potential POAF predictors reported in the literature (age, gender, body mass index, hypertension, and diabetes mellitus). P<0.05 was regarded as significant in the multivariate analysis. Results: Of the 151 patients, 34 (23%) developed POAF. In univariate analysis, six factors with P<0.1 (oral statin, dyslipidemia, iMg level after anesthesia induction, maximum and minimum iMg during surgery, and iMg level immediately before admission to ICU) were identified. In multivariate analysis including these and the five literature factors as explanatory variables, iMg immediately before admission to ICU emerged as a predictive factor for POAF (iMg≥0.46 mmol/L, OR 0.32, 95%CI 0.14-0.74, p=0.01) (standard iMg range: 0.48-0.60 mmol/L). Conclusion: The iMg level immediately before admission to ICU may be associated with the development of POAF. A further study is needed to evaluate changes in iMg in the ICU and iMg at the time of onset of POAF.
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Affiliation(s)
- Kotaro Hizuka
- Anesthesiology, Saitama Medical Center, Saitama Medical University, Kawagoe, JPN
| | - Takao Kato
- Anesthesiology, Saitama Medical Center, Saitama Medical University, Kawagoe, JPN
| | - Yuki Shiko
- Biostatistics, Clinical Research Center, Chiba University Hospital, Chiba, JPN.,Anesthesiology, Saitama Medical Center, Saitama Medical University, Kawagoe, JPN
| | - Yohei Kawasaki
- Emergency Medicine, Japanese Red Cross College of Nursing, Tokyo, JPN.,Biostatistics, Clinical Research Center, Chiba University Hospital, Chiba, JPN.,Anesthesiology, Saitama Medical Center, Saitama Medical University, Kawagoe, JPN
| | - Kaoru Koyama
- Anesthesiology, Saitama Medical Center, Saitama Medical University, Kawagoe, JPN
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Jannati M, Shahbazi S, Eshaghi L. Comparison of the Efficacy of Oral versus Intravascular Magnesium in the Prevention of Hypomagnesemia and Arrhythmia after CABG. Braz J Cardiovasc Surg 2019; 33:448-453. [PMID: 30517252 PMCID: PMC6257533 DOI: 10.21470/1678-9741-2018-0070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 05/19/2018] [Indexed: 11/22/2022] Open
Abstract
Objective Cardiac arrhythmias are a common challenge following open-heart surgeries.
Hypomagnesemia is believed to be correlated with this condition.
Prophylactic intravenous magnesium supplementation has been practiced for a
long time in patients undergoing CABG. This study was designed in an attempt
to compare the efficacy of oral versus intravenous routes
in the prevention of hypomagnesemia and arrhythmia. Methods In this interventional clinical study, 82 patients were randomly assigned to
2 groups. All patients were evaluated for baseline serum magnesium level and
arrhythmias. One group received 1,600 mg of oral magnesium hydroxide through
nasogastric (NG) tube prior to surgery, while the other group received 2 g
of magnesium sulfate during the induction of anesthesia. The serum magnesium
level was monitored for 48 hours after the operation. The difference in
preoperative hypomagnesemia was non-significant (Sig: 0.576). Results During the operation, the serum magnesium level peaked around 4 mg/dL, and no
hypomagnesemia was detected in any patient. Although the curve of oral group
declined parallel and below that of intravenous (IV) group, no significant
differences were detected during postoperative monitoring. In addition, a
prevalence of arrhythmia of 13.9% and 6.5% was noticed in IV and oral
groups, respectively (OR: 0.428). Conclusion Providing 1,600 mg of oral magnesium supplement to patients is as effective
as 2,000 mg of magnesium sulfate IV in preventing hypomagnesemia and
arrhythmia after CABG. Thus, the authors introduce this treatment regimen as
a promising and cost-effective method.
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Affiliation(s)
- Mansour Jannati
- Cardiovascular Surgery Ward, Faghihi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Shahrbanoo Shahbazi
- Department of Anesthesiology, Shiraz Anesthesiology and Critical and Care Research Center, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Laleh Eshaghi
- Department of Anesthesiology, Shiraz University of Medical Sciences, Shiraz, Iran
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Yamashita K, Hu N, Ranjan R, Selzman CH, Dosdall DJ. Clinical Risk Factors for Postoperative Atrial Fibrillation among Patients after Cardiac Surgery. Thorac Cardiovasc Surg 2018; 67:107-116. [PMID: 30071562 DOI: 10.1055/s-0038-1667065] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Postoperative atrial fibrillation (POAF) is a common arrhythmia following cardiac surgery and is associated with increased health-care costs, complications, and mortality. The etiology of POAF is incompletely understood and its prediction remains suboptimal. Using data from published studies, we performed a systemic review and meta-analysis to identify preoperative clinical risk factors associated with patients at increased risk of POAF. METHODS A systematic search of PubMed, MEDLINE, and EMBASE databases was performed. RESULTS Twenty-four studies that reported univariate analysis results regarding POAF risk factors, published from 2001 to May 2017, were included in this meta-analysis with a total number of 36,834 subjects. Eighteen studies were performed in the United States and Europe and 16 studies were prospective cohort studies. The standardized mean difference (SMD) between POAF and non-POAF groups was significantly different (reported as [SMD: 95% confidence interval, CI]) for age (0.55: 0.47-0.63), left atrial diameter (0.45: 0.15-0.75), and left ventricular ejection fraction (0.30: 0.14-0.47). The pooled odds ratios (ORs) (reported as [OR: 95% CI]) demonstrated that heart failure (1.56: 1.31-1.96), chronic obstructive pulmonary disease (1.36: 1.13-1.64), hypertension (1.29: 1.12-1.48), and myocardial infarction (1.18: 1.05-1.34) were significant predictors of POAF incidence, while diabetes was marginally significant (1.06: 1.00-1.13). CONCLUSION The present analysis suggested that older age and history of heart failure were significant risk factors for POAF consistently whether the included studies were prospective or retrospective datasets.
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Affiliation(s)
- Kennosuke Yamashita
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, Utah, United States.,Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, United States
| | - Nan Hu
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, United States.,Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, United States
| | - Ravi Ranjan
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, Utah, United States.,Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, United States
| | - Craig H Selzman
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, Utah, United States.,Division of Cardiothoracic Surgery, Department of Surgery, University of Utah, Salt Lake City, Utah, United States
| | - Derek J Dosdall
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, Utah, United States.,Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, United States.,Division of Cardiothoracic Surgery, Department of Surgery, University of Utah, Salt Lake City, Utah, United States
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Baker WL. Treating arrhythmias with adjunctive magnesium: identifying future research directions. EUROPEAN HEART JOURNAL - CARDIOVASCULAR PHARMACOTHERAPY 2016:pvw028. [DOI: 10.1093/ehjcvp/pvw028] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Ganga HV, Noyes A, White CM, Kluger J. Magnesium adjunctive therapy in atrial arrhythmias. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2013; 36:1308-18. [PMID: 23731344 DOI: 10.1111/pace.12189] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Revised: 04/02/2013] [Accepted: 04/10/2013] [Indexed: 11/30/2022]
Abstract
Magnesium (Mg) is an important intracellular ion with cardiac metabolism and electrophysiologic properties. A large percentage of patients with arrhythmias have an intracellular Mg deficiency, which is out of line with serum Mg concentrations, and this may explain the rationale for Mg's benefits as an atrial antiarrhythmic agent. A current limitation of antiarrhythmic therapy is that the potential for cardiac risk offsets some of the benefits of therapy. Mg enhances the balance of benefits to harms by enhancing atrial antiarrhythmic efficacy and reducing antiarrhythmic proarrhythmia potential as well as providing direct antiarrhythmic efficacy when used as monotherapy in patients undergoing cardiothoracic surgery.
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Affiliation(s)
- Harsha V Ganga
- The Henry Low Heart Center, Hartford Hospital, Hartford, Connecticut
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