Epidemiology of new-onset atrial fibrillation following coronary artery bypass graft surgery

Filardo, Giovanni; Damiano, Ralph J.; Ailawadi, Gorav; Thourani, Vinod H.; Pollock, Benjamin D.; Sass, Danielle; Phan, Teresa K.; Nguyen, Hoa L.; Graca, Briget da

doi:10.1136/heartjnl-2017-312150

Cited by 94 publications

(91 citation statements)

References 28 publications

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“…Supporting our results, Filardo et al had the same result from their study [3] , and they reported that both ICU time and mechanical ventilation time were statistically associated with postoperative AF in the univariate analysis, but mechanical ventilation time is the only one correlated signi cantly with AF after analyzed by logistic analysis.…”

Section: Discussionsupporting

confidence: 90%

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New-Onset Atrial Fibrillation after Off-Pump Coronary Artery Bypass Grafting: Predictors and In-hospital Complications

Xu¹,

Fan²,

Chen³

2020

Preprint

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Objective To explore risk factors and in-hospital complications of new-onset atrial fibrillation (AF) after off-pump coronary artery bypass grafting (OPCAB). Methods In this study of 1344 patients who underwent isolated OPCAB from 2012 to 2015, patients were divided into AF and non-AF group according to whether new-onset postoperative AF occurred. Results The incidence of new-onset AF after OPCAB was 28.57%, mainly appeared within the first 4 days after surgery. After binary logistic regression analysis, age, peripheral vascular disease, median-sternotomy OPCAB, mechanical ventilation time, IABP were independent predictors of AF( p <0.001,OR 1.039,95%CI 1.023-1.055; p =0.007,OR 2.450,95%CI 1.282-4.684; p =0.044,OR 0.589,95%CI 0.351-0.987; p =0.013,OR 1.006,95%CI 1.001-1.011; p =0.007,OR 3.001,95%CI 1.356-6.642, respectively). Patients with AF have a significant higher risk of reoperation, re-entry into ICU, re-intubation, postoperative myocardial infarction, renal failure, and death ( p =0.013, p =0.015, p <0.001, p =0.037, p <0.001, p <0.001, respectively), also a longer re-ICU time ( p =0.014). Conclusion Advanced age, peripheral vascular disease, median-sternotomy OPCAB, mechanical ventilation time, IABP were independent predictors for new-onset AF after OPCAB. Postoperative AF was clearly associated with more in-hospital complications.

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Section: Discussionsupporting

confidence: 90%

“…within the incidence of prior studies [1][2] [3] . Age is one of the most consistent risk factors for postoperative AF in many previous literature [4] [15] , which was also supported by our research.…”

Section: Discussionmentioning

confidence: 99%

New-Onset Atrial Fibrillation after Off-Pump Coronary Artery Bypass Grafting: Predictors and In-hospital Complications

Xu¹,

Fan²,

Chen³

2020

Preprint

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“…2,3 However, despite having medications for POAF prophylaxis and early treatment, the incidence of postoperative atrial fibrillation has remained relatively constant after isolated CABG. 4 Increased postoperative glucose variability (GV) may contribute to atrial fibrillation and major adverse events after CABG and may be a feasible therapeutic target to reduce these poor outcomes. [5][6][7] GV refers to swings in glucose levels throughout the day, including hypoglycemic episodes, hyperglycemic episodes, and postprandial changes.…”

Section: Discussionmentioning

confidence: 99%

Increased glucose variability is associated with atrial fibrillation after coronary artery bypass

Clement

Alejo

DiNatale

et al. 2019

Journal of Cardiac Surgery

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Background Elevated preoperative hemoglobin A1c (HbA1c) is a predictor of poor outcomes following coronary artery bypass grafting (CABG), but the role of increased postoperative glucose variability (GV) is unknown. We hypothesized that short‐term postoperative GV is associated with an increased risk of postoperative atrial fibrillation following isolated CABG. Methods Multicenter retrospective study of 2073 patients who underwent isolated CABG from January 2012 to March 2018. Postoperative GV in the first 24 hours was measured by standard deviation, coefficient of variation, and mean amplitude of glycemic excursions. Multivariate logistic regression assessed the independent association of GV with postoperative atrial fibrillation. Results A total of 2073 patients met the study criteria, and 446 patients (21.5%) developed postoperative atrial fibrillation. Using multivariate logistic regression to adjust for covariates, postoperative atrial fibrillation was associated with increased 24‐hour GV (odds ratio [OR] = 1.16, 95% confidence interval [CI], 1.05‐1.27, P < 0.01) and increased 24‐hour mean glucose (OR = 1.14, 95% CI, 1.08‐1.21, P < 0.01). Thus, for every 10% increase in 24‐hour GV or 10 mg/dL increase in mean glucose, there was a 16% or 14% increased risk of postoperative atrial fibrillation respectively. Conclusions Increased 24‐hour GV and mean glucose are predictors of atrial fibrillation after CABG. Preoperative HbA1c is not a risk factor for postoperative atrial fibrillation after adjusting for postoperative mean glucose and GV. Further investigation is needed to determine the relationship between adherence to strict glucose control and adverse events following CABG.

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“…Postoperative atrial fibrillation (POAF) affects 15% to 30% of patients undergoing cardiac surgery [1,2]. It not only increases the length of hospitalization but has also been associated with higher postoperative morbidity and mortality [2].…”

Section: Invited Commentarymentioning

confidence: 99%

Invited Commentary

Mandal

2018

The Annals of Thoracic Surgery

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Epidemiology of new-onset atrial fibrillation following coronary artery bypass graft surgery

Abstract: Each year, ~800 000 people undergo CABG worldwide; >264 000 will develop post-CABG AF. Onset is typically 2-3 days post-CABG and episodes last, on average, several hours. Effective prophylaxis and management is urgently needed to reduce associated risks of adverse outcomes.

Cited by 94 publications

References 28 publications

New-Onset Atrial Fibrillation after Off-Pump Coronary Artery Bypass Grafting: Predictors and In-hospital Complications

New-Onset Atrial Fibrillation after Off-Pump Coronary Artery Bypass Grafting: Predictors and In-hospital Complications

Increased glucose variability is associated with atrial fibrillation after coronary artery bypass

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