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Open Access Research article

Prognostic factors of atrial fibrillation following elective coronary artery bypass grafting: the impact of quantified intraoperative myocardial ischemia

Efstratios N Koletsis1, Christos Prokakis1*, James R Crockett3, Panagiotis Dedeilias2, Matthew Panagiotou3, Nikolaos Panagopoulos1, Nikolaos Anastasiou4, Dimitrios Dougenis1 and Efstratios Apostolakis5

Author Affiliations

1 Cardiothoracic Surgery Department, University of Patras, School of Medicine, Patras, Greece

2 1st Cardiac Surgery Department. "Evangelismos" General Hospital, Athens, Greece

3 Cardiac Surgery Department, Athens Medical Center, Greece

4 Department of Thoracic Surgery, 1st IKA Hospital, Athens, Greece

5 Department of Cardiac Surgery, University of Ioannina, School of Medicine, Ioannina, Greece

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Journal of Cardiothoracic Surgery 2011, 6:127  doi:10.1186/1749-8090-6-127

Published: 3 October 2011

Abstract

Background

Atrial fibrillation (AF) occurs in 28-33% of the patients undergoing coronary artery revascularization (CABG). This study focuses on both pre- and peri-operative factors that may affect the occurrence of AF. The aim is to identify those patients at higher risk to develop AF after CABG.

Patients and methods

Two patient cohorts undergoing CABG were retrospectively studied. The first group (group A) consisted of 157 patients presenting AF after elective CABG. The second group (group B) consisted of 191 patients without AF postoperatively.

Results

Preoperative factors presenting significant correlation with the incidence of post-operative AF included: 1) age > 65 years (p = 0.029), 2) history of AF (p = 0.022), 3) chronic obstructive pulmonary disease (p = 0.008), 4) left ventricular dysfunction with ejection fraction < 40% (p = 0.015) and 5) proximal lesion of the right coronary artery (p = 0.023). The intraoperative factors that appeared to have significant correlation with the occurrence of postoperative AF were: 1) CPB-time > 120 minutes (p = 0.011), 2) myocardial ischemia index < 0.27 ml.m2/Kg.min (p = 0.011), 3) total positive fluid-balance during ICU-stay (p < 0.001), 4) FiO2/PO2 > 0, 4 after extubation and during the ICU-stay (p = 0.021), 5) inotropic support with doses 15-30 μg/Kg/min (p = 0.016), 6) long ICU-stay recovery for any reason (p < 0.001) and perioperative myocardial infarction (p < 0.001).

Conclusions

Our results suggest that the incidence of post-CABG atrial fibrillation can be predicted by specific preoperative and intraoperative measures. The intraoperative myocardial ischemia can be sufficiently quantified by the myocardial ischemia index. For those patients at risk we would suggest an early postoperative precautionary anti-arrhythmic treatment.

Keywords:
post-CABG atrial fibrillation; cardiopulmonary bypass; coronary artery bypass grafting; CABG; Myocardial Ischemia Index; postoperative supraventricular arrhythmias; predictors