The Role of Blood Transfusion in the Development of Atrial Fibrillation after Coronary Artery Bypass Grafting

Abstract

Atrial fibrillation (AF) is the most common complication after coronary artery bypass grafting (CABG). It is associated with prolonged hospital stay and increased cost. The aim of this study is to investigate the relationship between transfusion of blood derivatives and occurrence of postoperative paroxysmal AF. From June 2012 to February 2014, 446 patients undergoing CABG with cardiopulmonary bypass (CPB) were prospectively evaluated for occurrence of postoperative AF. Patients and procedural variables were recorded and were associated with the development of new-onset AF with logistic regression analysis. AF developed in 111 patients (24.9%). Preoperative factors associated with the development of new-onset AF included age ( < 0.05), higher EuroSCORE II ( < 0.05), carotid disease ( = 0.01), peripheral vascular disease ( = 0.02), chronic obstructive pulmonary disease ( = 0.03), renal failure ( = 0.05), and cardiac failure ( = 0.01). Intraoperative and postoperative parameters included duration of CPB ( < 0.05), number of grafts ( = 0.009), intubation time ( = 0.001), occurrence of postoperative stroke ( = 0.01), transient ischemic attack ( = 0.02), need for prolonged ventilation ( = 0.002), development of respiratory tract infection ( = 0.02), need for noninvasive ventilation ( = 0.001), reintubation ( = 0.02), development of postoperative acute kidney injury ( = 0.002), and postoperative neurocognitive dysfunction ( = 0.002). The number of red blood cell (RBC) units transfused during surgery ( = 0.7) and the total number of RBC units transfused ( = 0.2) as well as units of fresh frozen plasma ( = 0. 7) and platelets units transfused in total ( = 0.3) were not found to increase the risk of postoperative AF. Intraoperative and postoperative blood products transfusion in patients operated for CABG is not associated with increased risk of developing postoperative AF.

Risk of Incident Non-Valvular Atrial Fibrillation after Dialysis-Requiring Acute Kidney Injury

“…Most of the previous studies evaluating the association between AF and AKI were designed with a relatively short study period using patients who underwent cardiac surgeries [ 6 , 7 ]. One such study enrolled 446 cardiac surgical patients and found that the development of postoperative AKI was an independent factor associated with new-onset AF [ 6 ].…”

“…Most of the previous studies evaluating the association between AF and AKI were designed with a relatively short study period using patients who underwent cardiac surgeries [ 6 , 7 ]. One such study enrolled 446 cardiac surgical patients and found that the development of postoperative AKI was an independent factor associated with new-onset AF [ 6 ]. Another prospective study including 2572 cardiac surgical patients disclosed that the occurrence of postoperative AKI carried the 1.7-fold increased risk of developing postoperative AF [ 7 ].…”

“…Nevertheless, the influence of AKI on subsequent incident AF has not been fully addressed in previous research. Most investigations only evaluate the concurrent occurrence of AKI and AF in a limited number of patients undergoing cardiac surgeries within a relatively short follow-up period [ 6 , 7 ]. In these studies, the development of postoperative AKI was found as an independent factor associated with the new-onset postoperative AF [ 6 , 7 ].…”

“…Most investigations only evaluate the concurrent occurrence of AKI and AF in a limited number of patients undergoing cardiac surgeries within a relatively short follow-up period [ 6 , 7 ]. In these studies, the development of postoperative AKI was found as an independent factor associated with the new-onset postoperative AF [ 6 , 7 ]. In line with these interpretations, new-onset AF after AKI in a nationwide survey for an extended followed-up period is necessary [ 7 , 8 , 9 , 10 ].…”

Blood transfusion and risk of atrial fibrillation after coronary artery bypass graft surgery

“…Previous studies assessed the association of RBC transfusion and the risk of postoperative AF after cardiac surgery. [ 8 , 14 – 20 ] However, these studies have a modest sample size and convey inconclusive results. To obtain a more comprehensive estimate of the association between BT and the risk of postoperative AF after cardiac surgery, we conducted a meta-analysis to systematically evaluate the association between BT and the risk of postoperative AF in adult patients who had undergone CABG surgery.…”