scholarly journals Predictors of atrial fibrillation recurrence after surgical ablation of long-standing persistent AF with concomitant coronary artery bypass grafting

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
A Kalybekova ◽  
V Lukinov ◽  
S Rakhmonov ◽  
A Chernyavskyi
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Logistic Regression ◽  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Right Atrium ◽  
Artery Bypass ◽  
Surgical Ablation ◽  
Additional Intervention ◽  
History Of

Abstract Background A long-standing persistent form of atrial fibrillation (AF) in anamnesis, requiring surgical ablation together with coronary artery bypass surgery (CABG), significantly increases the risk of reccurence in the postoperative period. Before operation should consider the predictors of AF for long-term preservation of rhythm after surgery. Purpose To evaluate the predictors of AF recurrence on 3rd day and at discharge in patients after CABG with concomitant surgical ablation of long-standing persistent AF. Methods A prospective randomized single-center analysis was performed on patients with long-standing persistent AF, undergoing CABG with concomitant left atrial ablation (LAA) or biatrial ablation (BA) between 2016 and 2019. 116 patients were randomized into two groups: 58 in LAA+CABG, 58 in BA+CABG. The median age of the patients was 65 (IQR, 61 to 67.75) years in gr. BA and 62 (IQR, 58 to 66) in gr. LAA (Mann-Whitney U-test, p=0.050), 83% of men were in gr. BA (Fisher test, p>0.999). Predictors of AF development on day 3 were identified using multivariable logistic regression from the following baseline characteristics: myocardial infarction in anamnesis, time of artificial circulation, time of application of radiofrequency energy, the size of the left and right atrium, funcrional class of cardiac angina and heart failure, gender, age, acute cerebrovascular accident (CVA), additional intervention on the heart (operations for aortic aneurysm, mitral, aortic and tricuspid valves replacement), concomitant cardiovascular, respiratory, digestive and urogenital diseases. Results Using a multivariate model of logistic regression, the following significant predictors of arrhythmias on the 3rd day in gr. BA were included: additional intervention on the heart valves (OR 63.13, p=0.001); an increase in the functional class (FC) of chronic heart failure (CHF) NYHA by 1 (OR 40.06, p=0.018); a history of CVA (OR 9.13, p=0.026). The following significant predictors of AF reccurence on the 3rd day in gr.LAA were identified: an increase in the long axis of the right atrium by 1 cm (OR 3.05, p=0.006); an increase of the FC of cardiac angina by 1 (OR 7.11, p=0.011); in women (OR 7.14, p=0.017). In BA significant predictors of AF reccurence at discharge were: an increase in the long axis of the left atrium by 1 cm (OR4.86, p=0.015); reccurence of AF on the 3rd day (OR 17.45, p=0.005); 1 year increase in age (OR 1.24, p=0.023); the presence of diabetes (OR 47.67, p=0.002). In gr. LAA the predictors at discharge were: reccurence of AF on 3rd day (OR 38.35, p=0.001); a history of CVA increases the chances of arrhythmia (OR 210.83, p=0.032). Conclusion Number of clinical and functional characteristics of a patient may be predictors of AF. We examined the predictors of reccurence of AF after surgical ablation of long-standing persistent AF with concomitant CABG. Taking them into account when choosing the optimal strategy of treatment is important. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals Long-Term Survival Following Surgical Ablation for Atrial Fibrillation Concomitant to Isolated and Combined Coronary Artery Bypass Surgery—Analysis from the Polish National Registry of Cardiac Surgery Procedures (KROK)

2020 ◽  
Vol 9 (5) ◽  
pp. 1345
Author(s):  
Mariusz Kowalewski ◽  
Marek Jasiński ◽  
Jakub Staromłyński ◽  
Marian Zembala ◽  
Kazimierz Widenka ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cardiac Surgery ◽  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
National Registry ◽  
Surgical Ablation ◽  
Term Survival ◽  
Long Term Survival

The current investigation aimed to evaluate long-term survival in patients undergoing isolated and combined coronary artery bypass grafting (CABG) with concomitant surgical ablation for atrial fibrillation (AF). Procedural data from KROK (Polish National Registry of Cardiac Surgery Procedures) were retrospectively collected. Eleven thousand three hundred sixteen patients with baseline AF (72.4% men, mean age 69.6 ± 7.9) undergoing isolated and combined CABG surgery between 2006–2019 in 37 reference centers across Poland and included in the registry were analyzed. The median follow-up was four years (3.7 IQR 1.3–6.8). Over a 12-year study period, there was a significant survival benefit (Hazard Ratio (HR) 0.83; (95% Confidence Interval (CI): 0.73–0.95); p = 0.005) with concomitant ablation as compared to no concomitant ablation. After rigorous propensity matching (LOGIT model, 432 pairs), concomitant surgical ablation was associated with over 25% improved survival in the overall analysis: HR 0.74; (95% CIs: 0.56–0.98); p = 0.036. The benefit of concomitant ablation was maintained in the subgroups, yet the most benefit was appraised in low-risk patients (EuroSCORE < 2, p = 0.003) with the three-vessel disease (p < 0.001) and without other comorbidities. Ablation was further associated with significantly improved survival in patients undergoing CABG with mitral valve surgery (HR 0.62; (95% CIs: 0.52–0.74); p < 0.001) and in patients in whom complete revascularization was not achieved: HR 0.43; (95% CIs: 0.24–0.79); p = 0.006.

scholarly journals Management of Atrial Fibrillation in Patients Undergoing Coronary Artery Bypass Grafting

2018 ◽  
Vol 13 (6) ◽  
pp. 383-390 ◽  
Author(s):  
Ali J. Khiabani ◽  
Taylan Adademir ◽  
Richard B. Schuessler ◽  
Spencer J. Melby ◽  
Marc R. Moon ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Maze Procedure ◽  
Success Rates ◽  
Surgical Ablation ◽  
Mortality And Morbidity ◽  
Randomized Controlled Studies ◽  
Increased Risk

Untreated atrial fibrillation is associated with an increased risk of all-cause mortality and morbidity. Despite the current guidelines recommending surgical ablation of atrial fibrillation at the time of coronary artery bypass surgery, most patients with concomitant atrial fibrillation and coronary artery disease do not receive surgical ablation for their atrial fibrillation. This review reports the efficacy of different surgical ablation techniques used for the treatment of atrial fibrillation during coronary artery bypass. PubMed was systematically searched for studies reporting outcomes of concomitant surgical ablation in coronary artery bypass patients between January 2002 and March 2018. Data were independently extracted and analyzed by two investigators. Twenty-four studies were included. Twelve studies exclusively reported outcomes of surgical ablation in patients undergoing coronary artery bypass, whereas the remaining 12 reported outcomes of concomitant cardiac surgery with subgroup analysis. Only four studies performed the concomitant Cox-Maze procedure. Freedom from atrial tachyarrhythmia was reported as high as 98% at 1 year and 76% at 5 years with Cox-Maze procedure, whereas lesser lesion sets had more variable outcomes, ranging from 35% to 93%. In most studies, the addition of surgical ablation was not associated with increased morbidity and mortality. Although the Cox-Maze procedure had the greatest short- and long-term success rates, most studies comprising the evidence documenting the safety and efficacy of adding surgical ablation were of low or moderate quality. There was a great deal of heterogeneity among study populations, follow-up times, methods, and definition of failure. To establish a consensus regarding a surgical ablation technique for atrial fibrillation in coronary artery bypass population, larger multicenter randomized controlled studies need to be designed.

Perioperative Risk Factors of Atrial Fibrillation Post CABG Surgeries, a Retrospective Non-Randomized Study

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Mohsen Abdel Karim ◽  
Ahmed Helmy Omar ◽  
Tamer El-Shahat Hikal ◽  
Hazem Mohamed Youssef
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Artery Bypass Graft ◽  
University Hospitals ◽  
Significant Relation ◽  
History Of

Abstract Background Atrial fibrillation represents a common complication after coronary artery bypass and valvular surgery, although it is a benign arrhythmia it may contribute to the morbidity, high cost and prolonged ICU stay. Objectives The purpose of this study is to investigate and analyze the incidence and risk factors associated with postoperative atrial fibrillation (POAF) and its impact on intensive care unit (ICU) and postoperative hospital stay in patients undergoing coronary artery bypass graft surgeries (CABG) at Ain Shams University hospitals using the medical records of patients who underwent(CABG) surgeries from July 2018 to July 2019. Patients and Methods Our study was conducted in Ain Shams University hospitals from July 2018 to July 2019. This study was a retrospective non randomized on total 660 patients who undergone isolated Coronary artery bypass graft surgeries (CABG) during this period, of them we targeted 100 cases who developed POAF after surgery. Results Our results show that age, history of hypertension,smoking,history of renal impairment and recent myocardial infarction were all predictors of atrial fibrillation after cardiac surgery. POAF developed more frequent in patients who had larger left atrium diameter and lower ejection fraction. Our present results indicate that there is significant association between longer bypass and cross clamping time and development of POAF. We also found that patients who had postoperative lower serum potassium experienced more frequent POAF than who had normal potassium levels. In our study, we found that use of preoperative beta blocking drugs reduces risk of developing POAF. Early electrocardiographic ischemic postop. changes was also associated with high risk to develop POAF. No significant relation between use of intra-aortic balloon pump and development of POAF. Also, no significant relation between POAF and development of stroke or thromboembolic manifestations as POAF is usually self limiting,transient and resolves spontaneously in most of cases. Conclusion The current study found that low ejection fraction, dilated left atrium, hypertension, smoking, old age, male gender, prolonged bypass time, prolonged cross clamping time, renal impairment, previous myocardial infarction, ungrafted dominant right coronary artery, low temperatures on bypass, early ischemic changes postoperative, hypokalemia, use of adrenaline and nor adrenaline, all of these factors were a significant predictors for development of atrial fibrillation after cardiac surgery.

Analysis of Risk Factors for Myocardial Infarction and Cardiac Mortality after Major Vascular Surgery

2000 ◽  
Vol 93 (1) ◽  
pp. 129-140 ◽  
Author(s):  
Juraj Sprung ◽  
Basem Abdelmalak ◽  
Alexandru Gottlieb ◽  
Catharine Mayhew ◽  
Jeffrey Hammel ◽  
...  
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Vascular Surgery ◽  
Coronary Artery Bypass ◽  
Cardiac Death ◽  
Artery Bypass ◽  
History Of ◽  
Artery Disease

Background Patients undergoing vascular surgical procedures are at high risk for perioperative myocardial infarction (PMI). This study was undertaken to identify predictors of PMI and in-hospital death in major vascular surgical patients. Methods From the Vascular Surgery Registry (6,948 operations from January 1989 through June 1997) the authors identified 107 patients in whom PMI developed during the same hospital stay. Case-control patients (patients without PMI) were matched at a 1x:x1 ratio with index cases according to the type of surgery, gender, patient age, and year of surgery. The authors analyzed data regarding preoperative cardiac disease and surgical and anesthetic factors to study association with PMI and cardiac death. Results By using univariable analysis the authors identified the following predictors of PMI: valvular disease (P = 0.007), previous congestive heart failure (P = 0.04), emergency surgery (P = 0.02), general anesthesia (P = 0.03), preoperative history of coronary artery disease (P = 0.001), preoperative treatment with beta-blockers (P = 0.003), lower preoperative (P = 0.03) and postoperative (P = 0.002) hemoglobin concentrations, increased bleeding rate (as assessed from increased cell salvage; P = 0.025), and lower ejection fraction (P = 0.02). Of the 107 patients with PMI, 20.6% died of cardiac cause during the same hospital stay. The following factors increased the odds ratios for cardiac death: age (P = 0.001), recent congestive heart failure (P = 0.01), type of surgery (P = 0.04), emergency surgery (P = 0.02), lower intraoperative diastolic blood pressure (P = 0.001), new intraoperative ST-T changes (P = 0.01), and increased intraoperative use of blood (P = 0.005). Patients who underwent coronary artery bypass grafting, even more than 12 months before index surgery, had a 79% reduction in risk of death if they had PMI (P = 0.01). Multivariable analysis revealed preoperative definitive diagnosis of coronary artery disease (P = 0.001) and significant valvular disease (P = 0.03) were associated with increased risk of PMI. Congestive heart failure less than 1 yr before index vascular surgery (P = 0. 0002) and increased intraoperative use of blood (P = 0.007) were associated with cardiac death. The history of coronary artery bypass grafting reduced the risk of cardiac death (P = 0.04) in patients with PMI. Conclusions The in-hospital cardiac mortality rate is high for patients who undergo vascular surgery and experience clinically significant PMI. Stress of surgery (increased intraoperative bleeding and aortic, peripheral vascular, and emergency surgery), poor preoperative cardiac functional status (congestive heart failure, lower ejection fraction, diagnosis of coronary artery disease), and preoperative history of coronary artery bypass grafting are the factors that determine perioperative cardiac morbidity and mortality rates.

scholarly journals December 2020 Pulmonary Case of the Month: Resurrection or Medical Last Rites?

2020 ◽  
Vol 21 (6) ◽  
pp. 128-135
Author(s):  
Lewis Wesselius ◽  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Coronary Artery ◽  
Artery Bypass ◽  
Chronic Atrial Fibrillation ◽  
Community Acquired Pneumonia ◽  
Bypass Grafting ◽  
The Past ◽  
History Of ◽  
Artery Disease

No abstract available. Article truncated after the first page. History of Present Illness An 88-year-old man who has been short of breath and febrile up to 101.5° F for the past day presented on October 20, 2020. He has no known sick contacts or exposure to COVID-19. PMH, SH, and FH • No reported pulmonary history although he had a Xopenex MDI which he rarely used. • Coronary artery disease with prior coronary artery bypass grafting (1978); multiple subsequent stents; chronic atrial fibrillation; pacemaker (Micra) • Stage 3-4 CKD (creatinine 1.95) • Chronically on warfarin Physical Examination • Temp 37.3, Sat 92% on RA, 95% on 2 lpm, • Lungs: Few crackles in right upper chest • CV: regular, no murmur • Ext: 1 to 2+ edema (chronic, uses TED hose) Which of the following is/are the most likely diagnosis? 1. Community-acquired pneumonia 2. Congestive heart failure 3. COVID-19 4. 1 and 3 5. Any of the above …

scholarly journals Echocardiography is useful to predict postoperative atrial fibrillation in patients undergoing isolated coronary bypass surgery: A prospective study

2017 ◽  
Vol 8 (2) ◽  
pp. 104-113 ◽  
Author(s):  
Julien Magne ◽  
Baptiste Salerno ◽  
Dania Mohty ◽  
Claire Serena ◽  
Florence Rolle ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Coronary Artery ◽  
Coronary Artery Bypass Graft ◽  
Coronary Artery Bypass ◽  
Left Atrial ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Postoperative Atrial Fibrillation ◽  
Artery Bypass Graft ◽  
History Of

Objective: Postoperative atrial fibrillation is a major complication following coronary artery bypass graft. We hypothesized that, beyond clinical and electrocardiogram (ECG) data, transthoracic echocardiography could improve the prediction of postoperative atrial fibrillation. Methods: We prospectively studied 169 patients in sinus rhythm who underwent isolated coronary artery bypass graft in our institution. Clinical, biological, ECG and transthoracic echocardiography data were collected within 24 h before surgery. The patients were continuously monitored during the first five days, and then had daily 12-lead ECG afterwards until discharge. Postoperative atrial fibrillation was defined by any episode >10 min. Results: Postoperative atrial fibrillation was found in 65 patients (38%). Compared with those without, patients with postoperative atrial fibrillation were significantly older ( p=0.008), had more frequently a history of hypertension ( p=0.009), history of atrial fibrillation ( p<0.001) and New York Heart Association class ⩾III ( p=0.004). They also had longer PR interval ( p=0.005), higher preoperative NT-pro brain natriuretic peptide level ( p=0.006), left ventricle end-diastolic volume ( p=0.002), indexed left ventricle mass ( p<0.0001), indexed maximal left atrial volume ( p<0.0001), maximal right atrial area ( p<0.001) and lower left ventricle ejection fraction ( p=0.04). In multivariate analysis, history of atrial fibrillation (odds ratio =6.1, 95% confidence interval: 1.4–26.0, p=0.02) and indexed maximal left atrial volume (odds ratio =1.13, 95% confidence interval: 1.1–1.2, p=0.001) were the only two independent predictive factors of postoperative atrial fibrillation. The addition of echocardiographic parameters improved the predictive value (χ2) of the model, from 34 to 57. Conclusion: A history of atrial fibrillation and indexed left atrial maximal volume are the best predictors of the occurrence of postoperative atrial fibrillation following coronary artery bypass graft. The identification of high risk population of postoperative atrial fibrillation using these two factors could lead to the development of targeted strategies to limit this frequent complication in these patients.

scholarly journals Clinical and functional features of patients with acute coronary syndrome and history of coronary artery bypass grafting

2020 ◽  
Vol 27 (4) ◽  
pp. 18-24
Author(s):  
V. V. Matiy ◽  
M. V. Rishko ◽  
O. O. Kutsin
Keyword(s):  
Heart Failure ◽  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Artery Bypass Grafting ◽  
Coronary Syndrome ◽  
History Of

The aim – to investigate the clinical and functional parameters features in acute coronary syndrome and coronary artery bypass grafting history patients.Materials and methods. 68 patients with acute coronary syndrome (ACS) were examined according to the current protocols, in 30 of them there was a history of coronary artery bypass grafting (ACS and CABG group) and 38 patients who didn’t undergo CABG (ACS without CABG group). Physical and laboratory-instrumental methods of investigation, including ECG, echocardiography, coronary ventriculography, coronary artery bypass graft angiography and methods of variation statistics were used in the work.Results and discussion. Among patients with ACS and CABG, a history of a higher incidence and duration of stable angina pectoris, arterial hypertension, diabetes mellitus, and multiple concomitant pathology had been found in comparison with the ACS without CABG group. History of ACS and CABG patients comprised a higher incidence of ACS without ST segment elevation in comparison with ACS without CABG group, repeated ACS, heart failure progression and those patients needed significantly longer stay in ICU than ACS without CABG group. Electrocardiograms of patients with ACS and CABG vs ACS without CABG group were characterized by a significantly higher incidence of pathological Q, atrial and ventricular fibrillation, as well as a combined disturbances of rhythm and conduction. Echocardiography revealed a significantly lower ejection fraction, increase in left atrium size and an E/A ratio in the ACS and CABG group, indicating worse heart failure compensation as well as systolic and diastolic dysfunction with dysfunctional of left ventricular than in ACS without CABG patients.Conclusions. Acute coronary syndrome with coronary artery bypass grafting history patients are characterized by a complicated history and clinical course with more significant electrocardiogram and echocardiography changes in comparison to the group of acute coronary syndrome patients without prior coronary artery bypass grafting history.

scholarly journals Atrial fibrillation in patients with coronary heart disease: current state of the problem

2021 ◽  
Vol 12 (4) ◽  
pp. 66-74
Author(s):  
Aleksandr S. Zotov ◽  
Emil R. Sakharov ◽  
Sergey V. Korolev ◽  
Olga V. Drakina ◽  
Robert I. Khabazov ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Coronary Revascularization ◽  
Artery Bypass ◽  
Postoperative Mortality ◽  
Surgical Ablation ◽  
Term Survival ◽  
Mortality And Morbidity

Atrial fibrillation is one of the most common types of cardiac arrhythmia observed in clinical practice. Despite advances in the diagnosis and treatment, atrial fibrillation remains one of the leading causes of cardiovascular mortality and morbidity. In addition, atrial fibrillation is quite often combined with other pathologies of the cardiovascular system and is a marker of an unfavorable outcome. Several previous studies have demonstrated reduced survival in patients with coronary artery disease and atrial fibrillation who have not undergone surgery for arrhythmia. According to other data, the presence of preoperative atrial fibrillation among patients undergoing isolated coronary artery bypass grafting was associated with significantly higher rates of major postoperative complications. Nowadays, no one doubts the fact that atrial fibrillation during a coronary artery bypass surgery is a risk factor for increased hospital mortality, postoperative morbidity and leads to a decrease in the long-term survival. The studies confirm the necessity of surgical ablation for atrial fibrillation during coronary revascularization to reduce both short-term and long-term postoperative mortality and late complications.

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