Incidence And Risk Factors Of Atrial Fibrillation After Coronary Bypass Graft Surgery
Abstract
Background.Atrial fibrillation (AF) is a frequent complication after coronary artery bypass grafting (CABG). It is associated with an increased risk of mortality and morbidity, predisposes patients to a higher risk of stroke, requires additional treatment, and increases the costs of the post-operative care. This study aimed to determine the incidence, timing, and risk factors for AF after CABG in National Cardiovascular Centre Harapan Kita.Methods.We conducted a retrospective cohort study in 138 consecutive patients with sinus rhythm who underwent CABG. The endpoint of study was new onset in hospital AF.
Results.AF developed in 36 patients (26,1%). AF occurred 2,67 ± 1,91days (range 0–7 days) after CABG with a peak incidence on postoperative day 2 and 28 patients (77%) had AF within the first 3 day after CABG. Univariate analysis showed that age = 60 years (P<0.001) and number of graft > 3 (P=0.042) were associated with postoperative atrial fibrillation. In multivariate analysis, age = 60 years (P<0.001) RR 6.198 was found to be independent risk factor of AF following CABG.
Conclusions.The incidence of post CABG AF is 26.1% and its independent risk factor is age = 60 years.
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References
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Andrews TC, Reimold SC, Berlin JA, Antman EM. Prevention of supraventricular arrhythmias after coronary artery bypass surgery. A meta-analysis of randomized control trials. Circulation. 1991; 84(5 Suppl): III236-44.
Echahidi N, Pibarot P, O’Hara G, Mathieu P. Mechanisms, prevention, and treatment of atrial fibrillation after cardiac surgery. J Am Coll Cardiol. 2008; 51: 793-801.
Aranki SF, Shaw DP, Adams DH, Rizzo RJ, Couper GS, VanderVliet M, dkk. Predictors of atrial fibrillation after coronary artery surgery. Current trends and impact on hospital resources. Circulation. 1996; 94: 390-7.
Villareal RP, Hariharan R, Liu BC, Kar B, Lee VV, Elayda M, dkk. Postoperative atrial fibrillation and mortality after coronary artery bypass surgery. J Am Coll Cardiol. 2004; 43: 742-8.
Zaman AG, Archbold RA, Helft G, Paul EA, Curzen NP, Mills PG. Atrial fibrillation after coronary artery bypass surgery: a model for preoperative risk stratification. Circulation. 2000; 101: 1403-8.
Maisel WH, Rawn JD, Stevenson WG. Atrial fibrillation after cardiac surgery. Ann Intern Med. 2001;135(12):1061-1073.
Mathew JP, Fontes ML, Tudor IC, Ramsay J, Duke P, Mazer CD, et al. A multicenter risk index for atrial fibrillation after cardiac surgery. JAMA. 2004; 291: 1720-9.
Kaireviciute D, Aidietis A, Lip GY. Atrial fibrillation following cardiac surgery: clinical features and preventative strategies. Eur Heart J. 2009; 30 : 410-25.
Jongnarangsin K, Oral H. Postoperative atrial fibrillation. Cardiol Clin. 2009; 27: 69-78.
Haghjoo M, Basiri H, Salek M, Sadr-Ameli MA, Kargar F, Raissi K, Omrani G, dkk. Predictors of postoperative atrial fibrillation after coronary artery bypass graft surgery. Indian Pacing Electrophysiol J. 2008; 8: 94-101.
Almassi GH, Schowalter T, Nicolosi AC, Aggarwal A, Moritz TE, Henderson WG, dkk. Atrial fibrillation after cardiac surgery: a major morbid event? Ann Surg. 1997; 226: 501-11.
Chandy J, Nakai T, Lee RJ, Bellows WH, Dzankic S, Leung JM. Increases in P-wave dispersion predict postoperative atrial fibrillation after coronary artery bypass graft surgery. Anesth Analg. 2004; 98: 303-310.
Mariscalco G, Lorusso R, Klersy C, Ferrarese S, Tozzi M, Vanoli D, dkk. Observational study on the beneficial effect of preoperative statins in reducing atrial fibrillation after coronary surgery. Ann Thorac Surg. 2007; 84: 1158-64.
Shen T, Shan Q, Yuan B, Yang B, Chen C, Xu D, dkk. Predictors of post coronary artery bypass grafting atrial fibrillation. J Nanjing Med Univ. 2007; 21: 139-42.
Hashimoto K, Ilstrup DM, Schaff HV. Influence of clinical and hemodynamic variables on risk of supraventricular tachycardia after coronary artery bypass. J Thorac Cardiovasc Surg. 1991; 101: 56-65.
Bruins P, te Velthuis H, Yazdanbakhsh AP, Jansen PG, van Hardevelt FW, de Beaumont EM, dkk. Activation of the complement system during and after cardiopulmonary bypass surgery: postsurgery activation involves C-reactive protein and is associated with postoperative arrhythmia. Circulation. 1997; 96: 3542-8.
Aouifi A, Piriou V, Blanc P, Bouvier H, Bastien O, Chiari P, dkk. Effect of cardiopulmonary bypass on serum procalcitonin and C-reactive protein concentrations. Br J Anaesth. 1999; 83: 602-7.
Tsikouris JP, Kluger J, Song J, White CM. Changes in P-wave dispersion and P-wave duration after open heart surgery are associated with the peak incidence of atrial fibrillation. Heart Lung. 2001; 30: 466-71.
Kalman JM, Munawar M, Howes LG, Louis WJ, Buxton BF, Gutteridge G, Tonkin AM. Atrial fibrillation after coronary artery bypass grafting is associated with sympathetic activation. Ann Thorac Surg. 1995; 60: 1709-15.
Hogue CW, Jr., Domitrovich PP, Stein PK, Despotis GD, Re L, Schuessler RB, et al. RR interval dynamics before atrial fibrillation in patients after coronary artery bypass graft surgery. Circulation. 1998; 98: 429-34.
Ishii Y, Schuessler RB, Gaynor SL, Yamada K, Fu AS, Boineau JP, Damiano RJ, Jr. Inflammation of atrium after cardiac surgery is associated with inhomogeneity of atrial conduction and atrial fibrillation. Circulation. 2005; 111: 2881-8.
Tselentakis EV, Woodford E, Chandy J, Gaudette GR, Saltman AE. Inflammation effects on the electrical properties of atrial tissue and inducibility of postoperative atrial fibrillation. J Surg Res. 2006; 135: 68-75.
Lamm G, Auer J, Weber T, Berent R, Ng C, Eber B. Postoperative white blood cell count predicts atrial fibrillation after cardiac surgery. J Cardiothorac Vasc Anesth. 2006; 20: 51-6.
Hogue CW, Jr., Creswell LL, Gutterman DD, Fleisher LA. Epidemiology, mechanisms, and risks: American College of Chest Physicians guidelines for the prevention and management of postoperative atrial fibrillation after cardiac surgery. Chest. 2005; 128 (2 Suppl): 9S-16S.
Amar D, Shi W, Hogue CW, Jr., Zhang H, Passman RS, Thomas B, dkk. Clinical prediction rule for atrial fibrillation after coronary artery bypass grafting. J Am Coll Cardiol. 2004; 44: 1248-53.
Stamou SC, Dangas G, Hill PC, Pfister AJ, Dullum MK, Boyce SW, dkk. Atrial fibrillation after beating heart surgery. Am J Cardiol. 2000; 86: 64-7.
Leitch JW, Thomson D, Baird DK, Harris PJ. The importance of age as a predictor of atrial fibrillation and flutter after coronary artery bypass grafting. J Thorac Cardiovasc Surg. 1990; 100: 338-42.
Fuller JA, Adams GG, Buxton B. Atrial fibrillation after coronary artery bypass grafting. Is it a disorder of the elderly? J Thorac Cardiovasc Surg. 1989; 97: 821-5.
Hakala T, Hedman A. Predicting the risk of atrial fibrillation after coronary artery bypass surgery. Scand Cardiovasc J. 2003; 37: 309-15.
Moe GK, Rheinboldt WC, Abildskov JA. A Computer Model of Atrial Fibrillation. Am Heart J. 1964; 67: 200-20.
Goette A, Juenemann G, Peters B, Klein HU, Roessner A, Huth C, Rocken C. Determinants and consequences of atrial fibrosis in patients undergoing open heart surgery. Cardiovasc Res. 2002; 54: 390-6.
Andrews TC, Reimold SC, Berlin JA, Antman EM. Prevention of supraventricular arrhythmias after coronary artery bypass surgery. A meta-analysis of randomized control trials. Circulation. 1991; 84(5 Suppl): III236-44.
Echahidi N, Pibarot P, O’Hara G, Mathieu P. Mechanisms, prevention, and treatment of atrial fibrillation after cardiac surgery. J Am Coll Cardiol. 2008; 51: 793-801.
Aranki SF, Shaw DP, Adams DH, Rizzo RJ, Couper GS, VanderVliet M, dkk. Predictors of atrial fibrillation after coronary artery surgery. Current trends and impact on hospital resources. Circulation. 1996; 94: 390-7.
Villareal RP, Hariharan R, Liu BC, Kar B, Lee VV, Elayda M, dkk. Postoperative atrial fibrillation and mortality after coronary artery bypass surgery. J Am Coll Cardiol. 2004; 43: 742-8.
Zaman AG, Archbold RA, Helft G, Paul EA, Curzen NP, Mills PG. Atrial fibrillation after coronary artery bypass surgery: a model for preoperative risk stratification. Circulation. 2000; 101: 1403-8.
Maisel WH, Rawn JD, Stevenson WG. Atrial fibrillation after cardiac surgery. Ann Intern Med. 2001;135(12):1061-1073.
Mathew JP, Fontes ML, Tudor IC, Ramsay J, Duke P, Mazer CD, et al. A multicenter risk index for atrial fibrillation after cardiac surgery. JAMA. 2004; 291: 1720-9.
Kaireviciute D, Aidietis A, Lip GY. Atrial fibrillation following cardiac surgery: clinical features and preventative strategies. Eur Heart J. 2009; 30 : 410-25.
Jongnarangsin K, Oral H. Postoperative atrial fibrillation. Cardiol Clin. 2009; 27: 69-78.
Haghjoo M, Basiri H, Salek M, Sadr-Ameli MA, Kargar F, Raissi K, Omrani G, dkk. Predictors of postoperative atrial fibrillation after coronary artery bypass graft surgery. Indian Pacing Electrophysiol J. 2008; 8: 94-101.
Almassi GH, Schowalter T, Nicolosi AC, Aggarwal A, Moritz TE, Henderson WG, dkk. Atrial fibrillation after cardiac surgery: a major morbid event? Ann Surg. 1997; 226: 501-11.
Chandy J, Nakai T, Lee RJ, Bellows WH, Dzankic S, Leung JM. Increases in P-wave dispersion predict postoperative atrial fibrillation after coronary artery bypass graft surgery. Anesth Analg. 2004; 98: 303-310.
Mariscalco G, Lorusso R, Klersy C, Ferrarese S, Tozzi M, Vanoli D, dkk. Observational study on the beneficial effect of preoperative statins in reducing atrial fibrillation after coronary surgery. Ann Thorac Surg. 2007; 84: 1158-64.
Shen T, Shan Q, Yuan B, Yang B, Chen C, Xu D, dkk. Predictors of post coronary artery bypass grafting atrial fibrillation. J Nanjing Med Univ. 2007; 21: 139-42.
Hashimoto K, Ilstrup DM, Schaff HV. Influence of clinical and hemodynamic variables on risk of supraventricular tachycardia after coronary artery bypass. J Thorac Cardiovasc Surg. 1991; 101: 56-65.
Bruins P, te Velthuis H, Yazdanbakhsh AP, Jansen PG, van Hardevelt FW, de Beaumont EM, dkk. Activation of the complement system during and after cardiopulmonary bypass surgery: postsurgery activation involves C-reactive protein and is associated with postoperative arrhythmia. Circulation. 1997; 96: 3542-8.
Aouifi A, Piriou V, Blanc P, Bouvier H, Bastien O, Chiari P, dkk. Effect of cardiopulmonary bypass on serum procalcitonin and C-reactive protein concentrations. Br J Anaesth. 1999; 83: 602-7.
Tsikouris JP, Kluger J, Song J, White CM. Changes in P-wave dispersion and P-wave duration after open heart surgery are associated with the peak incidence of atrial fibrillation. Heart Lung. 2001; 30: 466-71.
Kalman JM, Munawar M, Howes LG, Louis WJ, Buxton BF, Gutteridge G, Tonkin AM. Atrial fibrillation after coronary artery bypass grafting is associated with sympathetic activation. Ann Thorac Surg. 1995; 60: 1709-15.
Hogue CW, Jr., Domitrovich PP, Stein PK, Despotis GD, Re L, Schuessler RB, et al. RR interval dynamics before atrial fibrillation in patients after coronary artery bypass graft surgery. Circulation. 1998; 98: 429-34.
Ishii Y, Schuessler RB, Gaynor SL, Yamada K, Fu AS, Boineau JP, Damiano RJ, Jr. Inflammation of atrium after cardiac surgery is associated with inhomogeneity of atrial conduction and atrial fibrillation. Circulation. 2005; 111: 2881-8.
Tselentakis EV, Woodford E, Chandy J, Gaudette GR, Saltman AE. Inflammation effects on the electrical properties of atrial tissue and inducibility of postoperative atrial fibrillation. J Surg Res. 2006; 135: 68-75.
Lamm G, Auer J, Weber T, Berent R, Ng C, Eber B. Postoperative white blood cell count predicts atrial fibrillation after cardiac surgery. J Cardiothorac Vasc Anesth. 2006; 20: 51-6.
Hogue CW, Jr., Creswell LL, Gutterman DD, Fleisher LA. Epidemiology, mechanisms, and risks: American College of Chest Physicians guidelines for the prevention and management of postoperative atrial fibrillation after cardiac surgery. Chest. 2005; 128 (2 Suppl): 9S-16S.
Amar D, Shi W, Hogue CW, Jr., Zhang H, Passman RS, Thomas B, dkk. Clinical prediction rule for atrial fibrillation after coronary artery bypass grafting. J Am Coll Cardiol. 2004; 44: 1248-53.
Stamou SC, Dangas G, Hill PC, Pfister AJ, Dullum MK, Boyce SW, dkk. Atrial fibrillation after beating heart surgery. Am J Cardiol. 2000; 86: 64-7.
Leitch JW, Thomson D, Baird DK, Harris PJ. The importance of age as a predictor of atrial fibrillation and flutter after coronary artery bypass grafting. J Thorac Cardiovasc Surg. 1990; 100: 338-42.
Fuller JA, Adams GG, Buxton B. Atrial fibrillation after coronary artery bypass grafting. Is it a disorder of the elderly? J Thorac Cardiovasc Surg. 1989; 97: 821-5.
Hakala T, Hedman A. Predicting the risk of atrial fibrillation after coronary artery bypass surgery. Scand Cardiovasc J. 2003; 37: 309-15.
Moe GK, Rheinboldt WC, Abildskov JA. A Computer Model of Atrial Fibrillation. Am Heart J. 1964; 67: 200-20.
Goette A, Juenemann G, Peters B, Klein HU, Roessner A, Huth C, Rocken C. Determinants and consequences of atrial fibrosis in patients undergoing open heart surgery. Cardiovasc Res. 2002; 54: 390-6.
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How to Cite
Hadis, H., Yuniadi, Y., & Idham, I. (1). Incidence And Risk Factors Of Atrial Fibrillation After Coronary Bypass Graft Surgery. Indonesian Journal of Cardiology, 31(1), 16-25. https://doi.org/10.30701/ijc.v31i1.153
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Clinical Research
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