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(Circulation. 1996;94:390-397.)
© 1996 American Heart Association, Inc.
Articles |
Predictors of Atrial Fibrillation After Coronary Artery Surgery
Current Trends and Impact on Hospital Resources
the Division of Cardiac Surgery (S.F.A., D.P.S., D.H.A., R.J.R., G.S.C., J.J.C., L.H.C.), Department of Surgery, Brigham and Women's Hospital; and the Division of General Medicine (H.R.B., M.V.V.), Department of Medicine, Harvard Medical School, Boston, Mass.
Correspondence to Sary F. Aranki, MD, Division of Cardiac Surgery, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115.
Background Atrial fibrillation (AF) after coronary artery bypass surgery (CABG) is the most common sustained arrhythmia. Its pathophysiology is unclear, and its prevention and management remain suboptimal. The aim of this prospective study was to determine the current incidence of AF, identify its clinical predictors, and examine its impact on resource utilization.
Methods and Results Over a 12-month period ending July 31, 1994, a CABG procedure was performed on 570 consecutive patients (age range, 32 to 87 years; median age, 67 years; 232 [41%] were 
70 years; 175 [31%] were women; 173 [30%] were diabetics; 364 [65%] required nonelective surgery; 86 [15%] had had a prior CABG; and 86 [15%] had had prior percutaneous transluminal coronary angioplasty). AF occurred in 189 patients (33%). The median age for patients with AF was 71 years compared with 66 for patients without (P=.0001). Multivariate logistic regression analysis (odds ratio, ±95% CI, P value) was used to identify the following independent predictors of postoperative AF: increasing age (age 70 to 80 years [OR=2; CI, 1.3 to 3; P=.002], age >80 years [OR=3; CI, 1.6 to 5.8; P=.0007]), male gender (OR=1.7; CI, 1.1 to 2.7; P=.01), hypertension (OR=1.6; CI, 1.0 to 2.3; P=.03), need for an intraoperative intra-aortic balloon pump (OR=3.5; CI, 1.2 to 10.9; P=.03), postoperative pneumonia (OR=3.9; CI, 1.3 to 11.5; P=.01), ventilation for >24 hours (OR=2; CI, 1.3 to 3.2; P=.003), and return to the intensive care unit (OR=3.2; CI, 1.1 to 8.8; P=.03). The mean length of hospital stay after surgery was 15.3±28.6 days for patients with AF compared with 9.3±19.6 days for patients without AF (P=.001). The adjusted length of hospital stay attributable to AF was 4.9 days, corresponding to $10 055 in hospital charges.
Conclusions AF remains the most common complication after CABG and consequently is a drain on hospital resources. Concerted efforts to reduce the incidence of AF and the associated increased length of stay would result in substantial cost savings and decrease patient morbidity.
Key Words: atrial flutter • atrial fibrillation • coronary disease • bypass surgery
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C. W. Hogue Jr., L. L. Creswell, D. D. Gutterman, and L. A. Fleisher Epidemiology, Mechanisms, and Risks: American College of Chest Physicians Guidelines for the Prevention and Management of Postoperative Atrial Fibrillation After Cardiac Surgery Chest, August 1, 2005; 128(2_suppl): 9S - 16S. [Abstract] [Full Text] [PDF]
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L. L. Creswell, J. C. Alexander Jr., T. B. Ferguson Jr., A. Lisbon, and L. A. Fleisher Intraoperative Interventions: American College of Chest Physicians Guidelines for the Prevention and Management of Postoperative Atrial Fibrillation After Cardiac Surgery Chest, August 1, 2005; 128(2_suppl): 28S - 35S. [Abstract] [Full Text] [PDF]
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D. Bradley, L. L. Creswell, C. W. Hogue Jr., A. E. Epstein, E. N. Prystowsky, and E. G. Daoud Pharmacologic Prophylaxis: American College of Chest Physicians Guidelines for the Prevention and Management of Postoperative Atrial Fibrillation After Cardiac Surgery Chest, August 1, 2005; 128(2_suppl): 39S - 47S. [Abstract] [Full Text] [PDF]
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E. A. Martinez, E. B. Bass, and P. Zimetbaum Pharmacologic Control of Rhythm: American College of Chest Physicians Guidelines for the Prevention and Management of Postoperative Atrial Fibrillation After Cardiac Surgery Chest, August 1, 2005; 128(2_suppl): 48S - 55S. [Abstract] [Full Text] [PDF]
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E. A. Martinez, A. E. Epstein, and E. B. Bass Pharmacologic Control of Ventricular Rate: American College of Chest Physicians Guidelines for the Prevention and Management of Postoperative Atrial Fibrillation After Cardiac Surgery Chest, August 1, 2005; 128(2_suppl): 56S - 60S. [Abstract] [Full Text] [PDF]
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K. Prasongsukarn, J. G. Abel, W.R. E. Jamieson, A. Cheung, J. A. Russell, K. R. Walley, and S. V. Lichtenstein The effects of steroids on the occurrence of postoperative atrial fibrillation after coronary artery bypass grafting surgery: A prospective randomized trial J. Thorac. Cardiovasc. Surg., July 1, 2005; 130(1): 93 - 98. [Abstract] [Full Text] [PDF]
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Y. Ishii, R. B. Schuessler, S. L. Gaynor, K. Yamada, A. S. Fu, J. P. Boineau, and R. J. Damiano Jr Inflammation of Atrium After Cardiac Surgery Is Associated With Inhomogeneity of Atrial Conduction and Atrial Fibrillation Circulation, June 7, 2005; 111(22): 2881 - 2888. [Abstract] [Full Text] [PDF]
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K. Ak, S. Akgun, T. Tecimer, C. S. Isbir, A. Civelek, A. Tekeli, S. Arsan, and A. Cobanoglu Determination of Histopathologic Risk Factors for Postoperative Atrial Fibrillation in Cardiac Surgery Ann. Thorac. Surg., June 1, 2005; 79(6): 1970 - 1975. [Abstract] [Full Text] [PDF]
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J. Auer, G. Lamm, T. Weber, K. Mandal, M. Jahangiri, M. Mukhin, J. Poloniecki, A. J. Camm, and Q. Xu Letter Regarding Article by Mandal et al, "Association of Anti-Heat Shock Protein 65 Antibodies With Development of Postoperative Atrial Fibrillation" * Response Circulation, May 24, 2005; 111(20): e306 - e306. [Full Text] [PDF]
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A. Sedrakyan, T. Treasure, J. Browne, H. Krumholz, C. Sharpin, and J. van der Meulen Pharmacologic prophylaxis for postoperative atrial tachyarrhythmia in general thoracic surgery: Evidence from randomized clinical trials J. Thorac. Cardiovasc. Surg., May 1, 2005; 129(5): 997 - 1005. [Abstract] [Full Text] [PDF]
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B. Lo, R. Fijnheer, A. P. Nierich, P. Bruins, and C. J. Kalkman C-Reactive Protein is a Risk Indicator for Atrial Fibrillation After Myocardial Revascularization Ann. Thorac. Surg., May 1, 2005; 79(5): 1530 - 1535. [Abstract] [Full Text] [PDF]
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S Miller, E Crystal, M Garfinkle, C Lau, I Lashevsky, and S J Connolly Effects of magnesium on atrial fibrillation after cardiac surgery: a meta-analysis Heart, May 1, 2005; 91(5): 618 - 623. [Abstract] [Full Text] [PDF]
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J. Alex and L. Guvendik Evaluation of Ventral Cardiac Denervation As a Prophylaxis Against Atrial Fibrillation After Coronary Artery Bypass Grafting Ann. Thorac. Surg., February 1, 2005; 79(2): 517 - 520. [Abstract] [Full Text] [PDF]
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N. Ad, A. Schneider, I. Khaliulin, J. B. Borman, and H. Schwalb Impaired mitochondrial response to simulated ischemic injury as a predictor of the development of atrial fibrillation after cardiac surgery: In vitro study in human myocardium J. Thorac. Cardiovasc. Surg., January 1, 2005; 129(1): 41 - 45. [Abstract] [Full Text] [PDF]
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H. Kohno, T. Koyanagi, H. Kasegawa, and M. Miyazaki Three-Day Magnesium Administration Prevents Atrial Fibrillation After Coronary Artery Bypass Grafting Ann. Thorac. Surg., January 1, 2005; 79(1): 117 - 126. [Abstract] [Full Text] [PDF]
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T. Hakala, A. J.M. Valtola, A. K. Turpeinen, A. E. Hedman, R. E.U. Vuorenniemi, J. M. Karjalainen, I. S. Vajanto, J. Kouri, P. A. Jaakkola, and J. E.K. Hartikainen Right atrial overdrive pacing does not prevent atrial fibrillation after coronary artery bypass surgery Europace, January 1, 2005; 7(2): 170 - 174. [Abstract] [Full Text] [PDF]
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Y. Enc, B. Ketenci, D. Ozsoy, G. Camur, I. Kayacioglu, S. Terzi, and S. Cicek Atrial fibrillation after surgical revascularization: is there any difference between on-pump and off-pump? Eur. J. Cardiothorac. Surg., December 1, 2004; 26(6): 1129 - 1133. [Abstract] [Full Text] [PDF]
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T. Ege, E. Tatli, S. Canbaz, M. Cikirikcioglu, H. Sunar, B. Ozalp, and E. Duran The Importance of Intrapericardial Drain Selection in Cardiac Surgery Chest, November 1, 2004; 126(5): 1559 - 1562. [Abstract] [Full Text] [PDF]
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S. J. Kernis, V. T. Nkomo, D. Messika-Zeitoun, B. J. Gersh, T. M. Sundt III, K. V. Ballman, C. G. Scott, H. V. Schaff, and M. Enriquez-Sarano Atrial Fibrillation After Surgical Correction of Mitral Regurgitation in Sinus Rhythm: Incidence, Outcome, and Determinants Circulation, October 19, 2004; 110(16): 2320 - 2325. [Abstract] [Full Text] [PDF]
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J. M. Leung, W. H. Bellows, and N. B. Schiller Impairment of left atrial function predicts post-operative atrial fibrillation after coronary artery bypass graft surgery Eur. Heart J., October 2, 2004; 25(20): 1836 - 1844. [Abstract] [Full Text] [PDF]
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D. Amar, W. Shi, C. W. Hogue Jr, H. Zhang, R. S. Passman, B. Thomas, P. B. Bach, R. Damiano, and H. T. Thaler Clinical prediction rule for atrial fibrillation after coronary artery bypass grafting J. Am. Coll. Cardiol., September 15, 2004; 44(6): 1248 - 1253. [Abstract] [Full Text] [PDF]
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Y. Ishii, M. J. Gleva, M. C. Gamache, R. B. Schuessler, J. P. Boineau, M. S. Bailey, and R. J. Damiano Jr Atrial Tachyarrhythmias After the Maze Procedure: Incidence and Prognosis Circulation, September 14, 2004; 110(11_suppl_1): II-164 - II-168. [Abstract] [Full Text] [PDF]
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C. A. Palin, R. Kailasam, and C. W. Hogue Jr Atrial Fibrillation After Cardiac Surgery: Pathophysiology and Treatment Seminars in Cardiothoracic and Vascular Anesthesia, September 1, 2004; 8(3): 175 - 183. [Abstract] [PDF]
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J. Kerstein, A. Soodan, M. Qamar, M. Majid, E. Lichstein, G. Hollander, and J. Shani Giving IV and Oral Amiodarone Perioperatively for the Prevention of Postoperative Atrial Fibrillation in Patients Undergoing Coronary Artery Bypass Surgery: The GAP Study Chest, September 1, 2004; 126(3): 716 - 724. [Abstract] [Full Text] [PDF]
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D. E. Singer, G. W. Albers, J. E. Dalen, A. S. Go, J. L. Halperin, and W. J. Manning Antithrombotic Therapy in Atrial Fibrillation: The Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy Chest, September 1, 2004; 126(3_suppl): 429S - 456S. [Abstract] [Full Text] [PDF]
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J. Auer, T. Weber, R. Berent, G. Lamm, and B. Eber Serum potassium level and risk of postoperative atrial fibrillation in patients undergoing cardiac surgery J. Am. Coll. Cardiol., August 18, 2004; 44(4): 938 - 939. [Full Text] [PDF]
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J. E. MacDonald and A. D. Struthers Serum potassium level and risk of postoperative atrial fibrillation in patients undergoing cardiac surgery": Reply J. Am. Coll. Cardiol., August 18, 2004; 44(4): 939 - 939. [Full Text] [PDF]
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T. D. Nielsen, T. Bahnson, R. D. Davis, and S. M. Palmer Atrial Fibrillation After Pulmonary Transplant Chest, August 1, 2004; 126(2): 496 - 500. [Abstract] [Full Text] [PDF]
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