Incidence and Outcomes of Postoperative Atrial Fibrillation after Coronary Artery Bypass Grafting of a Randomized Controlled Trial: A Blinded End-of-cycle Analysis

Abstract

Objective:The objective of this study is to analyse the incidence of postoperative atrial fibrillation (POAF), demography, post-operative outcomes including morbidity and mortality, length of Cardiac Intensive Care Unit (CICU) stay, High Dependency Unit (HDU) stay, and total hospital stay in patients undergoing coronary bypass grafting (CABG) at Institut Jantung Negana (IJN). Methods: We conducted a prospective, randomised, controlled trial. We supplied the treatment group with Tocovid capsules and the control group with placebo containing palm superolein. Results: Since January 2019, we have recruited the target population of 250 patients. However, the result is still blinded as we are still analysing blood samples for tocotrienol levels. 89.2% of patients completed the study with a 3.6% mortality and a 7.6% attrition rate. 35.2% of the patients developed POAF, the mean time being 46.06 ± 26.96 hours post-CABG. We did not observe any statistically significant difference when we compared left atrial size, New York Heart Association (NYHA) functional class, ejection fraction and premorbid history, besides EuroSCORE II (The European System for Cardiac Operative Risk Evaluation II) status except for older age group, right atrial size, and pleural effusion. There was also no difference in bypass time, cross clamp time or number of anastomoses. However, we noted a significant difference in death (p = 0.01) and renal failure requiring dialysis (p = 0.007) among patients with POAF; those patients also had a longer CICU stay (p = 0.005), HDU stay (p = 0.02), and total hospital stay (p = 0.001). Conclusions: POAF is associated with a higher incidence of renal failure and death while it increases CICU, HDU, and total hospital stay. It remains to be seen whether Tocovid reduces POAF and its associated sequelae. Clinical Trial Registration: NCT03807037 (Registered on 16 January 2019).

Heart Rate Variability and Coronary Artery Bypass Grafting: A Systematic Review

“…Coronary artery bypass grafting (CABG) surgery is one of the leading therapeutic strategies for patients with significant CAD [ 1 ]. CABG surgery reduces manifestations and improves prognosis, but unfavorable cardiovascular events, including cardiac arrhythmias may be observed in post-CABG patients [ 1 , 2 , 3 ]. Importantly, changes in cardiac autonomic regulation are noted in these patients both before and after surgery and may be assessed non-invasively using heart rate variability (HRV) derived from a continuous electrocardiography (ECG) recordings.…”

Atrial fibrillation in vascular surgery: a systematic review and meta-analysis on prevalence, incidence and outcome implications

“…Nevertheless, the real weight and impact of AF in patients with arteriopathies undergoing vascular procedures or vascular surgery interventions is still unknown in terms of prevalence of a history of AF, incidence of POAF and implications for outcome. Indeed, while AF after cardiac surgery has been the object of many analyses and studies, [9][10][11][12][13][14] and AF after general or orthopedic surgery has recently attracted some interest, 3,6,15 very limited data are available on AF and vascular surgery.…”

Research Progress of Low-Voltage Areas Associated with Atrial Fibrillation

“…Atrial fibrillation (AF) is a common cardiac arrhythmia that is closely associated with adverse events such as ischemic stroke, heart failure, death, and decreased quality of life [ 1 ]. Heart rate control and rhythm control are two strategies for the treatment of AF.…”