Atrial fibrillation following cardiac surgery: risk analysis and long-term survival

Abstract

BackgroundWe studied potential risk factors for postoperative atrial fibrillation (POAF) in a large cohort of patients who underwent open-heart surgery, evaluating short- and long-term outcome, and we developed a risk-assessment model of POAF.MethodsA retrospective study of 744 patients without prior history of AF who underwent CABG (n = 513), OPCAB (n = 207), and/or AVR (n = 156) at Landspitali Hospital in 2002–2006. Logistic regression analysis was used to study risk factors for POAF, comparing patients with and without POAF.ResultsThe rate of POAF was 44%, and was higher following AVR (74%) than after CABG (44%) or OPCAB (35%). In general, patients with POAF were significantly older, were more often female, were less likely to be smokers, had a lower EF, and had a higher EuroSCORE. The use of antiarrythmics was similar in the groups but patients who experienced POAF were less likely to be taking statins. POAF patients also had longer hospital stay, higher rates of complications, and operative mortality (5% vs. 0.7%). In multivariate analysis, AVR (OR 4.4), a preoperative history of cardiac failure (OR 1.8), higher EuroSCORE (OR 1.1), and advanced age (OR 1.1) were independent prognostic factors for POAF. Overall five-year survival was 83% and 93% for patients with and without POAF (p <0.001).ConclusionPOAF was detected in 44% of patients, which is high compared to other studies. In the future, our assessment score will hopefully be of use in identifying patients at high risk of POAF and lower complications related to POAF.

Long-Term Suppression of Atrial Fibrillation by Botulinum Toxin Injection Into Epicardial Fat Pads in Patients Undergoing Cardiac Surgery

“…41 patients with postoperative AF also had longer total length of hospital stay, and specifically the stay in ICU can more than doubled. 42 Postoperative (<30 days) mortality was 5% in patients who were diagnosed with postoperative AF, when compared with only 0.7% in patients with postoperative normal sinus rhythm. The difference in survival is also reflected in long-term survival: an 83% 5-year survival for patients with postoperative AF and 93% for patients with postoperative normal sinus rhythm.…”

“…The difference in survival is also reflected in long-term survival: an 83% 5-year survival for patients with postoperative AF and 93% for patients with postoperative normal sinus rhythm. 42 Autonomic imbalance and the interaction between inflammatory substances inducing GP hyperactivity play a major role in the mechanism of postoperative AF. 43,44 The operative procedure results in release of inflammatory substances that could activate nerve endings of the atrial neural network, instigating AF, as shown in experimental models.…”

Árangur aðgerða við ósæðargúlp í rishluta ósæðar á Íslandi 2000-2014

“…Nýtil-komið gáttatif er einnig algengasti minniháttar fylgikvilli eftir aðrar hjartaskurðaðgerðir hér á landi og erlendis, en þá er tíðnin á bilinu 30-50%. 20,21 Af alvarlegum fylgikvillum reyndust fylgikvillarnir hjartadrep í kringum aðgerð (15,2%) og enduraðgerð vegna blaeðingar algengastir. Tíðni enduraðgerða vegna blaeðingar var 14,3%, sem er haerra en í flestum erlendum rannsóknum þar sem hlutfallið er oftast á bilinu 2-10%.…”

Intraoperative Magnesium Administration Does Not Reduce Postoperative Atrial Fibrillation After Cardiac Surgery

“…1-3 POAF has a peak incidence on postoperative day 2 4 and is associated with several adverse outcomes, including increased cardiovascular, renal, and cerebral complications; increased cost of care and resource utilization; and decreased long-term survival. 1,[5][6][7][8] Hypomagnesemia has been associated with an increased risk of AF, both after cardiac surgery 9,10 and in ambulatory settings. 11,12 Hypomagnesemia is believed to promote AF through a variety of mechanisms, including effects on atrioventricular conduction, action potential duration, and the atrial effective refractory period.…”