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Comparison of Two Central Venous Pressure Control Strategies to Prevent Atrial Fibrillation After Coronary Artery
Mario Augusto Cray da Costa1, Wesley Lirani1, Ana Caroline Wippich1
1Universidade Estadual de Ponta Grossa, Ponta Grossa, PR - Brazil.
Insights
Lowering central venous pressure (CVP) to ≤ 15 cmH2O in patients undergoing coronary artery bypass grafting (CABG) significantly reduced the incidence of atrial fibrillation (AF). This strategy may be beneficial for preventing post-CABG AF.
Area of Science:
- Cardiology
- Cardiac Surgery
- Critical Care Medicine
Background:
- Atrial fibrillation (AF) complicates 10-40% of coronary artery bypass grafting (CABG) procedures, increasing cardiovascular mortality.
- Enlarged atria are linked to higher AF incidence; elevated central venous pressure (CVP) may cause atrial distension, thus increasing AF risk.
Purpose of the Study:
- To compare post-CABG AF incidence between two CVP control strategies.
- To evaluate the impact of CVP management on AF development after CABG.
Main Methods:
- An interventional, randomized, controlled clinical study involving 140 patients undergoing CABG.
- Patients were randomized into two groups: G15 (CVP ≤ 15 cmH2O) and G20 (CVP ≤ 20 cmH2O).
- CVP was monitored and managed for the first 72 hours post-CABG.
Main Results:
- AF incidence was significantly lower in the G15 group (8.57%) compared to the G20 group (22.86%), with an absolute risk reduction of 14.28% and NNT of 7 (p=0.03).
- Mortality, hospital length of stay, number of grafts, and cardiopulmonary bypass use were similar between groups.
- Patients who developed AF had significantly higher age and hospital length of stay.
Conclusions:
- Maintaining CVP ≤ 15 cmH2O during the initial 72 hours post-CABG effectively reduces the relative risk of AF.
- Lowering CVP is a potentially valuable strategy for preventing atrial fibrillation after coronary artery bypass grafting.
Background::
Atrial fibrillation (AF) takes place in 10-40% of patients undergoing coronary artery bypass grafting (CABG), and increases cardiovascular mortality. Enlargement of atrial chambers is associated with increased AF incidence, so patients with higher central venous pressure (CVP) are expected to have larger atrial distension, which increases AF incidence.
Objective::
To compare post-CABG AF incidence, following two CVP control strategies.
Methods::
Interventional, randomized, controlled clinical study. The sample comprised 140 patients undergoing CABG between 2011 and 2015. They were randomized into two groups, G15 and G20, with CVP maintained ≤ 15 cmH2O and ≤ 20 cmH2O, respectively.
Results::
70 patients were included in each group. The AF incidence in G15 was 8.57%, and in G20, 22.86%, with absolute risk reduction of 14.28%, and number needed to treat (NNT) of 7 (p = 0.03). Mortality (G15 = 5.71%; G20 = 11.42%; p = 0.07), hospital length of stay (G15 = 7.14 days; G20 = 8.21 days; p = 0.36), number of grafts (median: G15 = 3, G2 = 2; p = 0.22) and cardiopulmonary bypass use (G15 = 67.10%; G20 = 55.70%; p = 0.22) were statistically similar. Age (p = 0.04) and hospital length of stay (p = 0.001) were significantly higher in patients who developed AF in both groups.
Conclusion::
Keeping CVP low in the first 72 post-CABG hours reduces the relative risk of AF, and may be useful to prevent AF after CABG.
Fundamento::
A fibrilação atrial (FA) ocorre em 10-40% dos pacientes submetidos a cirurgia de revascularização miocárdica (RM), e eleva a mortalidade cardiovascular. Como o aumento dos átrios está associado ao aumento da incidência de FA, espera-se que pacientes com pressão venosa central (PVC) mais alta tenham maior distensão atrial, o que eleva a incidência dessa arritmia.
Objetivo::
Comparar a incidência de FA em pós-operatório de RM, seguindo duas estratégias de controle de PVC.
MéTodos::
Estudo clínico randomizado controlado intervencionista. A amostra foi composta por 140 pacientes submetidos a RM entre 2011 e 2015. Os pacientes foram randomizados em dois grupos, G15 e G20, mantidos com PVC máxima de 15 cmH2O e 20 cmH2O, respectivamente.
Resultados::
Foram incluídos 70 pacientes em cada grupo. A incidência da arritmia em G15 foi de 8,57% e, no G20, de 22,86%, com redução de risco absoluto de 14,28% e número necessário para tratar (NNT) de 7 (p = 0,03). Mortalidade (G15 = 5,71%; G20 = 11,42%; p = 0,07), tempo de internamento (G15 = 7,14 dias; G20 = 8,21 dias; p = 0,36), número de enxertos (medianas: G15 = 3, G2 = 2; p = 0,22) e uso de circulação extracorpórea (G15 = 67,10%; G20 = 55,70%; p = 0,22) mostraram-se estatisticamente semelhantes. A idade (p = 0,04) e o tempo de internamento (p = 0,001) foram significativamente maiores nos pacientes que desenvolveram FA nos dois grupos.
ConclusãO::
Manter a PVC com valores mais baixos nas primeiras 72h após a cirurgia de RM reduz o risco relativo de FA e pode ser uma ferramenta útil na prevenção da FA após RM.
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