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Diastolic dysfunction, cardiopulmonary bypass, and atrial fibrillation after coronary artery bypass graft surgery
1Department of Anesthesia and Pain Management, EN 3-410, Toronto General Hospital, University Health Network, University of Toronto, 200 Elizabeth Street, Toronto, ON, Canada M5G 2C4 Present address: Department of Anaesthesia, c/o St Vincent's Hospital,390 Victoria Street, Darlinghurst, NSW 2010, Australia.
Insights
New or worsened diastolic dysfunction after coronary artery bypass graft surgery increases the risk of atrial fibrillation. This study highlights diastolic dysfunction as a key predictor of postoperative atrial fibrillation in CABG patients.
Area of Science:
- Cardiology
- Cardiac Surgery
- Cardiopulmonary Bypass
Background:
- Atrial fibrillation (AF) is a frequent complication post-coronary artery bypass graft (CABG) surgery.
- Diastolic dysfunction (DD) can alter left atrial structure and function, potentially increasing AF risk.
- The study investigates the association between perioperative diastolic function changes and postoperative AF.
Purpose of the Study:
- To determine if new or worsened diastolic dysfunction after cardiopulmonary bypass (CPB) is associated with a higher incidence of postoperative AF.
- To identify dynamic changes in diastolic function during the perioperative period that predict AF after CABG.
Main Methods:
- 109 patients undergoing elective CABG surgery were assessed for diastolic dysfunction (DD) before and after cardiopulmonary bypass (CPB).
- Patients were monitored for atrial fibrillation (AF) throughout their hospital stay.
- Statistical analysis identified independent predictors of postoperative AF.
Main Results:
- Diastolic dysfunction (DD) was prevalent, present in 81% before and 83% after CPB.
- 31% of patients experienced new or worsened DD after CPB.
- New or worsened DD was significantly associated with postoperative AF (OR 4.145, P=0.009), as was age ≥65.
Conclusions:
- New or worsened diastolic dysfunction following CABG surgery is a significant predictor of postoperative atrial fibrillation.
- Monitoring and managing diastolic function changes perioperatively may help mitigate AF risk in CABG patients.
Background:
Atrial fibrillation (AF) is a common complication after coronary artery bypass graft (CABG) surgery, and is associated with increased morbidity, mortality, and utilization of healthcare resources. Diastolic dysfunction (DD) causes a range of changes in left atrial structure and function that may predispose patients to increased risk of AF. We hypothesized that patients with either new or worsened grade of DD after cardiopulmonary bypass (CPB) would have higher prevalence of AF after CABG surgery. The current study sought to determine an association between the dynamic changes in diastolic function during the perioperative period and postoperative AF in patients undergoing CABG surgery.
Methods:
A total of 109 patients undergoing elective CABG surgery were assessed for the presence of DD before and after CPB. All patients were monitored for the development of AF after surgery for the entire hospital stay.
Results:
DD was present in 89 (81%) and 91 (83%) patients before and after CPB. Thirty-four (31%) patients had either new or worsened grade of DD after CPB. Postoperative AF was present in 30 (27.5%) patients, including 15 (44%) patients with either new or worsened DD, and 15 (20%) patients with either unchanged or improved DD (P=0.009). Independent predictors of postoperative AF included age ≥65 yr [odds ratio (OR) 4.207, 95% confidence interval (CI) 1.527, 11.588], and new or worsened DD (OR 4.145, 95% CI 1.519, 11.356).
Conclusions:
New or worsened DD after CABG surgery is associated with an increased incidence of postoperative AF.
Clinical Trial Registration:
http://www.clinicaltrials.gov; unique identifier NCT00188903.
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