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Postoperative atrial fibrillation in coronary artery bypass grafting herald poor outcome
Pulkit Malhotra1, Shantanu Pande1, Supaksh Mahindru1
1Department of Cardiovascular and Thoracic Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
Insights
Postoperative atrial fibrillation in patients undergoing coronary artery bypass grafting is linked to increased need for intraaortic balloon pump support, myocardial infarction, and death. This finding highlights the importance of monitoring and managing atrial fibrillation after cardiac surgery.
Area of Science:
- Cardiology
- Cardiac Surgery
- Electrophysiology
Background:
- Postoperative atrial fibrillation (POAF) is a common complication after cardiac surgery.
- While POAF is known to cause reduced cardiac output and cerebrovascular events, its impact on overall patient outcomes following coronary artery bypass grafting (CABG) remains incompletely understood.
Purpose of the Study:
- To investigate the effect of new-onset atrial fibrillation in the postoperative period on the outcomes of patients who underwent coronary artery bypass grafting.
Main Methods:
- A retrospective case-control study involving 263 patients who underwent CABG.
- Patients were divided into two groups: those who developed atrial fibrillation (Group I, n=24) and those who maintained normal sinus rhythm (Group II, n=239).
- Data collected included demographics, comorbidities, medications, operative details, and left ventricular function. The primary outcome was a composite of death and postoperative myocardial infarction (MI).
Main Results:
- The study groups were comparable in baseline characteristics and left ventricular function.
- Patients with POAF required intraaortic balloon pump (IABP) support more frequently (5 vs. 10, P=0.001).
- Although the composite endpoint of death or MI was not statistically significant (16.6% vs. 9.2%, P=0.1), there were significantly more deaths in the POAF group (4 vs. 7, P=0.002).
Conclusions:
- The occurrence of atrial fibrillation following coronary artery bypass grafting is associated with an increased incidence of intraaortic balloon pump use, myocardial infarction, and mortality.
- These findings underscore the clinical significance of POAF in predicting adverse outcomes in CABG patients.
Introduction:
Atrial fibrillation in postoperative period is common. Although the event of atrial fibrillation is associated with reduced cardiac output and its consequences and cerebrovascular events, its effect on outcome is not clearly documented. This study is done to evaluate the effect of atrial fibrillation on outcome of the operation.
Materials And Methods:
This is a retrospective case-control study. A total of 263 patients received coronary artery bypass grafting during this period. The data for demographics, comorbidities, preoperative medications, operative details, and echocardiographic parameters of left ventricular functions were acquired. A total of 24 patients had atrial fibrillation (Group I), while 239 remained in normal sinus rhythm (Group II). The outcome is measured as combined of death and postoperative myocardial infarction (MI).
Results:
The groups are comparable in demographic, preoperative medications, operative, and left ventricular parameters. Of the 24 (9.12%) patients who had postoperative atrial fibrillation, 11 were discharged on medical management. Nine patients reverted to sinus rhythm at discharge. Atrial fibrillation persisted in 8 patients 1 week after discharge and 3 patients after 1 month. The requirement of intraaortic balloon pump (IABP) was statistically significant in group I (5 in group I vs. 10 in group II, n = 0.001). There were 4 deaths in group 1 and 7 in group 2 (P = 0.002), however, the combined end point was achieved in 4 (16.6%) vs. 22 (9.2%), respectively, P = 0.1.
Conclusion:
The appearance of atrial fibrillation heralds increased requirement of IABP, MI, and death in patients undergoing coronary artery bypass grafting.
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