Predictors of postoperative atrial fibrillation after coronary artery bypass grafting: a prospective observational cohor
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Ain-Shams Journal of Anesthesiology
(2020) 12:55
ORIGINAL ARTICLE
Open Access
Predictors of postoperative atrial fibrillation after coronary artery bypass grafting: a prospective observational cohort study Hanaa A. El-Gendy1* , Mohamed H. Dabsha2, Gamal M. Elewa1 and Amr H. Ali1
Abstract Background: This study was conducted to determine the effect of certain predictors on the incidence of postoperative atrial fibrillation (POAF) during ICU stay after coronary artery bypass graft (CABG) surgery. Results: We enrolled 123 patients in this study. The mean age was 57.4 ± 8.7 years, and the mean left atrial diameter was 4.1 ± 0.52 cm with male preponderance (76.4%). The incidence of POAF following CABG was 33.3%. There was no statistically significant association between POAF and smoking (P = 0.123). However, POAF was significantly associated with higher CHA2DS2-VASc score (P = 0.002), valve replacement (P < 0.001), and inotropic support (P = 0.005). Moreover, patients with POAF had significantly higher mean age (P = 0.031) and left atrial (LA) diameter (P < 0.001). Logistic regression showed that LA diameter (P < 0.001), potassium level at 36 h (P = 0.016), and female gender (P = 0.001) were independent predictors of POAF. Conclusions: We had several significant epidemiological, clinical, and operative variables that were significantly associated with post-CABG AF, including older age, female gender, large LA diameter, valve replacement, higher CHA2DS2-VASc score, and postoperative inotropic support. However, only LA diameter, female gender, and potassium level at 36 h were independent predictors of POAF. Nevertheless, further large-scale studies are needed to confirm our findings. Keywords: Atrial fibrillation, Organ dysfunction scores, Coronary artery bypass, Postoperative complications, Intensive care units, Prognosis
Introduction Postoperative atrial fibrillation (POAF) is one of the most critical and common complications after cardiovascular surgery, precipitating early, and late morbidities. Incidence of POAF after coronary artery bypass graft (CABG) surgery is about 30%, about 40% after valve surgery, and about 50% after combined CABG and valve replacement/repair surgery, with peaks occurring two to 3 days after surgery (Chebbout et al., 2018). * Correspondence: [email protected]; [email protected] 1 Department of Anesthesiology, Intensive Care, and Pain Management, Faculty of Medicine, Ain Shams University, Cairo, Egypt Full list of author information is available at the end of the article
Postoperative atrial fibrillation may lead to hemodynamic instability, thromboembolic manifestation, prolonged hospital stay, readmissions to intensive care unit (ICU), organ failure, healthcare costs, and mortality. So, much attention is focused on the prevention of atrial fibrillation (AF) in high-risk patients (Lahtinen et al., 2004; Maisel et al., 2001). The pathophysiological mechanism of AF is complex and affected by various factors. A variety of diagnostic modalities are useful in predicting POA
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