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Nodal vessels disease as a risk factor for atrial fibrillation after coronary artery bypass graft surgery
S Al-Shanafey1, L Dodds, D Langille
1Cardiovascular Surgery Division, Maritime Heart Center, New Halifax Infirmary, Queen Elizabeth II Hospital, Nova Scotia, Halifax, Canada.
Insights
Diseased sinoatrial (SA) arteries are linked to atrial fibrillation (AF) after coronary artery bypass graft (CABG) surgery. This finding may help identify patients for prophylactic treatment to prevent AF post-CABG.
Area of Science:
- Cardiology
- Cardiac Surgery
- Vascular Surgery
Background:
- Atrial fibrillation (AF) is a frequent complication following coronary artery bypass graft (CABG) surgery.
- Atrial ischemia, potentially caused by diseased atrioventricular (AV) and sinoatrial (SA) arteries, is a proposed mechanism for post-CABG AF.
- Identifying predictors of AF post-CABG is crucial for patient management and prophylaxis.
Purpose of the Study:
- To investigate whether diseased nodal arteries (AV and SA) are significant predictors of developing AF after CABG.
- To determine the association between the presence of diseased SA and AV arteries and the incidence of AF post-CABG.
Main Methods:
- A case-control study comparing 100 patients with AF post-CABG to 100 controls without AF post-CABG.
- Pre-operative angiographic evidence of diseased nodal arteries was assessed.
- Multiple logistic regression analysis was used to evaluate the predictive value of diseased arteries for AF post-CABG, excluding patients older than 65 or with prior AF.
Main Results:
- While AV artery disease showed no significant association with AF post-CABG (OR=1.04, P=0.82), diseased SA arteries were significantly associated with AF development (OR=2.093, P=0.03).
- The AF group was older than the non-AF control group.
- Grafting of SA or AV nodal arteries did not significantly alter the risk of developing AF post-CABG.
Conclusions:
- The presence of a diseased sinoatrial artery is a significant predictor of atrial fibrillation after coronary artery bypass graft surgery.
- This association could aid in identifying patients at higher risk who may benefit from targeted prophylactic strategies to prevent post-CABG AF.
Objective:
Atrial fibrillation (AF) is common after coronary artery bypass graft (CABG) surgery. Atrial ischaemia due to diseased atrioventricular (AV) and sinoatrial (SA) arteries has been proposed as a cause of AF post-CABG. We examined if the presence of diseased nodal arteries was a significant predictor of the development of AF post-CABG.
Methods:
100 consecutive cases (AF post-CABG) were compared to 100 consecutive controls (No AF post-CABG) with respect to pre-operative angiographic evidence of diseased nodal arteries. Cases and controls identified from the Society of Thoracic Surgeons database underwent detailed chart reviews to obtain data on potential risk factors. Patients were excluded if they were undergoing anything but a routine CABG procedure, were older than 65 years, or had previous AF. All angiograms were reviewed by a single radiologist blinded to outcome. The effect of grafting diseased nodal arteries on the development of AF post-CABG was also measured. A multiple logistic regression model was utilized to measure the effect of disease in each artery on the development of AF post-CABG.
Results:
Cases and controls were comparable regarding potential risk factors, with the exception that the AF group was older than the non-AF group. Significant AV artery disease was detected in 78 cases compared to 74 controls (adjusted odds ratio (OR) OR=1.04, CI, 0.51-2.12, P=0.82). Significant SA artery disease was detected in 34 cases compared to 21 controls (adjusted OR=2.093, CI: 1.06-4.09, P=0.03). Six of ten patients having revascularization of their SA nodal artery developed AF versus 28 of 45 of those who did not (OR=0.91, CI: 0.18-5.06, P=0.58). Forty-eight of 87 patients having revasacularization of their AV nodal artery developed AF versus 30 of 65 of those who did not (OR=1.44, CI: 0.72-2.88, P=0.27).
Conclusion:
The presence of a diseased SA artery is significantly associated with AF post-CABG. Such association may be used to identify a subset of patients who might be targeted with prophylaxis.
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