Postoperative Atrial Fibrillation Among Patients Undergoing Isolated Coronary Artery Bypass Grafting

Atrial Fibrillation After Coronary Artery Bypass Grafting and Its Relationship with Hospital Complications in São Paulo State

INTRODUCTION

Atrial fibrillation is the main complication in the postoperative period of cardiovascular surgery. Its genesis is multifactorial, so its rapid identification to mitigate the associated risks is essential.

OBJECTIVE

To evaluate the incidence of atrial fibrillation in patients undergoing coronary artery bypass grafting (CABG) and its relationship with other complications in our setting.

METHODS

This is a multicenter, observational study involving patients undergoing isolated CABG between 2017 and 2019 with data from the Registro Paulista de Cirurgia Cardiovascular (or REPLICCAR II). Variables were prospectively collected in REDCap following the definitions given by version 2.73 of the Society of Thoracic Surgeons Adult Cardiac Surgery Database. Data were collected with prior authorization from the local ethics committee and analyses performed in R software.

RESULTS

A total of 3,803 patients were included, of these 605 had postoperative atrial fibrillation (POAF). In order to adjust the groups, propensity score matching was used. Such analyses resulted in 605 patients in each group (without POAF vs. with POAF). Among patients with POAF, the mean age was 67.56 years, with a prevalence of males (73.6%, 445 patients). Patients belonging to the group with POAF had a mortality rate of 9.26% (P=0.007), longer ventilation time (P<0.001), pneumonia (P<0.001), and sepsis (P<0.001). In multiple analysis, acute renal dysfunction (P=0.032) and longer intensive care unit stay (P<0,001) were associated with the presence of POAF.

CONCLUSION

POAF in CABG is associated with longer intensive care unit and hospital stay, as well as renal dysfunction, pneumonia, and in-hospital mortality.

Does prophylactic low-dose amiodarone decrease the incidence of postoperative atrial fibrillation after coronary artery bypass graft surgery? A randomized controlled trial

Background

Postoperative atrial fibrillation (POAF) occurs within 1 to 5 days after coronary artery bypass grafting (CABG), with a peak occurrence on the second day. This research aimed to assess the role of dose-low amiodarone in the prevention of POAF after CABG.

Methods

This randomized controlled blind-single study was carried out on 150 patients undergoing elective CABG with sinus rhythm. Cases were randomized into two equal groups. The placebo group received matching placebo tablets. The amiodarone group received a prophylactic oral amiodarone 5 mg/kg/day for 6 days before and 6 days after surgery.

Results

The incidence of POAF was significantly lower in the amiodarone group compared to the placebo group (16% vs 33.3%, P = 0.013) with a relative risk of 0.48 times (95% confidence interval: 0.26–0.88). The onset of POAF, percent of patients responded to medication, and time elapsed to respond to medication were insignificantly different between both groups. The mean (± SD) of ICU stay was 2.51 ± 1.11 days in the amiodarone group versus 3.31 ± 1.83 days in the placebo group, and the mean (± SD) of hospital stay duration was 10 ± 1.99 days in the amiodarone group versus 12.72 ± 2.23 days in the placebo group. The length of ICU admission and hospital stay was significantly lower in the amiodarone group than in the placebo group (P = 0.002 and < 0.001, respectively).

Conclusions

Low-dose oral amiodarone was effective in POAF prevention after CABG with a lower length of ICU admission and hospital stay.

Trial registration

Pan African Clinical Trials Register PACTR202101651961317. Registered on 21 January 2021

Clinical characteristics and prognostic factors of atrial fibrillation at a tertiary center of Pakistan - From a South-Asian perspective - A cross-sectional study

Background

There is lack of large data from South-Asian region on atrial fibrillation and it is imperative that clinical presentation, prognostic factors, management pursued, and outcomes are known for this part of the world. Once collective evidence for the region is known, region-specific guidelines can be laid forward.

Objectives

To evaluate clinical characteristics and prognostic factors of atrial fibrillation at a tertiary care center of Pakistan.

Methods

This was a retrospective study conducted at a tertiary care center of Pakistan. Period of study ranged from July–December 2018. All hospitalized patients who were admitted with atrial fibrillation as a primary or associated diagnosis were enrolled.

Results

A total of 636 patients were enrolled. The mean age was 68.5 ± 12 years and 49.5% (315) were male. 90.6% of the patients were admitted via emergency room. Majority (59.9%) had previously known AF and 40% developed new-onset AF during the hospital stay. Hypertension was the most common co-morbid condition (85.4%) followed by Diabetes Mellitus (40.1%). At least 9% had rheumatic heart disease. The median CHA₂DS₂VASc and HASBLED scores were 4 and 2 respectively. More than one-third of patients had sepsis as a primary diagnosis (36.8%). The in-hospital mortality of patients with atrial fibrillation was 6.7%. Patients with new-onset AF had higher mortality. Sepsis and stroke were independently associated with a higher mortality. There was no significant difference in median CHA₂DS₂VASc and HASBLED scores for patients with new-onset and previously known AF. On discharge, 83% of the eligible patients received oral anticoagulation.

Conclusion

There was higher prevalence of chronic co-morbid conditions in the studied population leading to a higher CHA₂DS₂VASC Score. Sepsis and stroke were independently associated with higher in-hospital mortality.

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Sepsis and stroke are independently associated with higher in-hospital mortality in patients with atrial fibrillation.

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There is higher prevalence of chronic co-morbid conditions in the studied population.

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Hypertension is the most common co-morbid condition associated with atrial fibrillation.