scholarly journals Subacute postoperative atrial fibrillation after heart surgery: incidence and predictive factors in cardiac rehabilitation

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
V Rizza ◽  
F Maranta ◽  
L Cianfanelli ◽  
R Grippo ◽  
C Meloni ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cardiac Surgery ◽  
Hospital Stay ◽  
Heart Surgery ◽  
Troponin T ◽  
Management Strategies ◽  
Inpatient Rehabilitation ◽  
Postoperative Atrial Fibrillation ◽  
Funding Sources ◽  
Valvular Surgery

Abstract Funding Acknowledgements Type of funding sources: None. Background. Postoperative atrial fibrillation (POAF) is the most common arrhythmic complication following cardiac surgery. It may occur between the second and fourth postoperative days as acute POAF, or within 30 days as subacute POAF (sPOAF). The incidence varies from 15% to 60%, with the highest rates observed in patients undergoing valvular surgery. POAF is associated with longer hospital stay and higher thromboembolic risk, which consistently increase patients’ morbidity and mortality. Identification of high-risk categories may allow optimization of in-hospital prevention and treatment, possibly improving clinical outcomes. Aim of the study. The aim of this study was to assess the incidence of sPOAF and to identify possible predictors in patients performing Cardiovascular Rehabilitation (CR) after Cardiac Surgery (CS). Methods. A single-centre retrospective study was performed on 383 post-cardiac surgery patients hospitalised in our CR Unit for inpatient rehabilitation. The entire population was on sinus rhythm at the admission in CR and continuous monitoring with 12-lead ECG telemetry was performed during the hospital stay. We calculated the incidence of sPOAF and then evaluated the predictive value of the following variables: anamnestic data, type of cardiac intervention, clinical course in both CS and CR Unit, laboratory parameters including baseline neutrophil-to-lymphocyte ratio (NLR). Results. Median age was 65 years (63% male). sPOAF was documented in 122 cases (31.9%). Patients developing sPOAF were older [median age 69 (63-76) vs. 61 (51-70); p < 0.001)], more frequently underwent complex surgical procedures (50% vs. 36%; p = 0.009) and were known for previous episodes of atrial fibrillation (27.9% vs. 11.2%; p < 0.001). On the first day after surgery (T1), sPOAF group showed higher values of glycemia [median 155 (126.5–186.8) vs. 129 (106.5–164); p < 0.001] and troponin T [median 721.5 (470.1–1084.3) vs. 488 (301.6-776.2); p < 0.001]. The multivariate analysis identified advanced age (OR 1.04, 95% CI 1.01-1.08; p = 0.023), acute POAF in the Cardiac Surgery Unit (OR 3.51, 95% CI 1.62-7.59; p = 0.001), baseline NLR (OR 1.46, 95% CI 1.10-1.93; p = 0.008) and T1-troponin > 552 ng/L (OR 4.16 95% CI 1.50-11.53; p = 0.006) as independent risk predictors of sPOAF during the CR period. Conclusions. sPOAF is common after cardiac surgery occurring in 31.9% of patients during CR. Age, acute POAF, baseline NLR and elevated troponin T on the first postoperative day were shown predictors of increased sPOAF risk. Recognition of new predictors of POAF could be helpful to better stratify patients, improving management strategies and outcomes.

scholarly journals Importance of Postoperative Atrial Fibrillation Development in Heart Surgery: Intra-Hospital Outcomes in Santa Catarina Tertiary Cardiology Center

2019 ◽  
Vol 32 (2) ◽  
pp. 76-81
Author(s):  
Ricardo Pereira da Silva ◽  
Larissa Freitas Nunes Goldoni ◽  
Kárila Scarduelli Luciano ◽  
Ana Carolina Gern Junqueira ◽  
Ana Carolina Caldara Barreto ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cardiac Surgery ◽  
Hospital Stay ◽  
Heart Surgery ◽  
Beta Blockers ◽  
Postoperative Atrial Fibrillation ◽  
Santa Catarina ◽  
Coronary Syndrome ◽  
Duration Of Hospital Stay

Objective: To determine the incidence of postoperative atrial fibrillation (PAF) of cardiac surgery, its impact on morbimortality and duration of hospital stay in a tertiary cardiology center of the state of Santa Catarina, Brazil. Methods: Cohort study with 134 adult patients submitted to cardiac surgery. Results: the incidence was 32.8%. After multivariate analysis, patients who did not receive beta-blockers were associated with PAF with a relative risk odds ratio (RR) 10.73 (p <0.001). The highest rate of cardiovascular events (cerebrovascular accident, mortality, and acute coronary syndrome) was 25% in the PAF group. 10% (RR 3.21; p = 0.035) which, consequently, generated longer hospitalization time in these patients (19.1 vs. 12.5; p = 0.01). Conclusion: the incidence of PAF was high, caused a significant increase in morbimortality and duration of hospital stay, and consolidated the role of beta-blocker therapy in its prevention, and may serve as a basis for future prevention policies.

Abstract 2270: Preoperative Metabolic Therapy Improves Cardiac Surgical Outcomes: A Prospective Randomized Clinical Trial

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Franklin L Rosenfeldt ◽  
Jee Y Leong ◽  
Salvatore Pepe ◽  
Juliana Van der Merwe ◽  
Donald S Esmore ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Multivariate Analysis ◽  
Cardiac Surgery ◽  
Hospital Stay ◽  
Lipoic Acid ◽  
Troponin I ◽  
Myocardial Damage ◽  
Postoperative Hospital Stay ◽  
Postoperative Atrial Fibrillation ◽  
Metabolic Therapy

In the current era the typical patient presenting for cardiac surgery is elderly with multiple co-morbidities. These high-risk patients contribute disproportionately to postoperative morbidity and mortality. We have shown that metabolic therapy with antioxidants such as coenzyme Q 10 (Co Q 10 ) and lipoic acid as well as energy substrate precursors such as orotate have protective effects on the stressed myocardium. We postulated that such therapy would reduce myocardial damage and improve post-operative recovery. Aim: To assess the effects of perioperative metabolic therapy on clinical and biochemical outcomes of cardiac surgery. Methods: Patients ( n =117), mean age 65 years, 74% male, undergoing elective coronary artery bypass graft (CABG) or valve surgery were randomised to receive daily for a minimum of 2 weeks before, and 4 weeks after surgery, metabolic therapy consisting of CoQ 10 300mg, magnesium orotate 1.2g, alpha lipoic acid 300mg, fish oil 999 mg and selenium 200 μg or placebo. Results: In the whole group, metabolic therapy vs placebo was associated (multivariate analysis) with lower 24-hour postoperative plasma troponin I (1.44 ± 0.25 vs 2.65 ± 0.61 ug/L, p =0.003) and reduced postoperative hospital stay (6.9± 0.04 vs 8.1 ± 0.04 days, p =0.002). In CABG alone group (n=70), metabolic therapy reduced the incidence of postoperative atrial fibrillation (23% vs 46%, p =0.04, multivariate analysis). Conclusions: Metabolic therapy before cardiac surgery is associated with: Reduced myocardial damage (troponin I release); Shortened postoperative hospital stay; Reduced incidence of postoperative atrial fibrillation in CABG patients. Clinical and economic benefits may be expected from general application of this therapy.

Abstract 4102: Preoperative Angiotensin Blocking Drug Therapy Does Not Reduce Atrial Fibrillation After Cardiac Surgery

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Florian Rader ◽  
Eugene H Blackstone
Keyword(s):  
Atrial Fibrillation ◽  
Cardiac Surgery ◽  
Drug Therapy ◽  
Propensity Score ◽  
Ace Inhibitors ◽  
Postoperative Atrial Fibrillation ◽  
Consecutive Series ◽  
Blocking Drug ◽  
Valvular Surgery ◽  
Co Morbidity

Introduction: Postoperative atrial fibrillation (POAF) is a common complication after cardiac surgery. Angiotensin blocking drug therapy (ABDT) with Angiotensin converting enzyme (ACE) inhibitors and Angiotensin II receptor blockers (ARBs) has been shown to have anti-arrhythmic effects in animal models. However, data from small observational studies of ABDT use in patients undergoing cardiac surgery had discordant results and did not sufficiently adjust for selection bias. Therefore, we performed the largest study to date examining the association between preoperative use of ABDT and postoperative atrial fibrillation. Methods and Results: A consecutive series of 10,552 patients underwent coronary artery bypass graft (CABG) surgery with or without valvular surgery at Cleveland Clinic between 1997 through 2002. Of these 4,795 (45%) patients were on ABDT within 30 days prior to surgery and 3,633 (34%) patients developed POAF prior to discharge. Without adjusting for patient co-morbidities, ABDT had an Odds Ratio (OR) of 1.13 (95% Confidence Interval (CI) 1.05–1.25, p<0.01). A propensity score matched sample was developed, adjusting for 68 potential confounders. In the 6874 matched patients, who had a well balanced co-morbidity profile, ABDT was not associated with POAF (OR 1.03, CI 0.93–1.12, p=0.67). A subsequent propensity score matched analysis of 3227 patients, who underwent isolated valvular surgery in the same timeframe, also demonstrated ineffectiveness of preoperative ABDT (OR 0.91, CI 0.74 –1.09, p=0.33), irrespective of valve location. Stratified analysis by linear propensity score quintiles and propensity-adjusted logistic multivariable regression analysis of all patients in the CABG and the valvular surgery cohort confirmed these findings. Conclusions: In this large observational study preoperative use of ACE inhibitors or ARBs did not reduce postoperative occurrence of atrial fibrillation in patients undergoing cardiac surgery. Although withdrawal from ABDT prior to surgery is common practice and could account for this result, we cannot recommend such therapy for primary prophylaxis without larger randomized controlled trials.

scholarly journals Postoperative Atrial Fibrillation Independently Predicts Prolongation of Hospital Stay after Cardiac Surgery

EP Europace ◽  
2005 ◽  
Vol 7 ◽  
pp. S1-S1 ◽  
Author(s):  
J AUER ◽  
T WEBER ◽  
R BERENT ◽  
C NG ◽  
G LAMM ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cardiac Surgery ◽  
Hospital Stay ◽  
Postoperative Atrial Fibrillation

scholarly journals NT-Pro BNP Secretion and Clinical Endpoints in Cardiac Surgery Intensive Care Patients

2007 ◽  
Vol 35 (3) ◽  
pp. 363-369 ◽  
Author(s):  
P. M. Jogia ◽  
M. Kalkoff ◽  
J. W. Sleigh ◽  
A. Bertinelli ◽  
M. La Pine ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cardiac Surgery ◽  
Intensive Care ◽  
Troponin T ◽  
Postoperative Recovery ◽  
Primary Objective ◽  
Postoperative Atrial Fibrillation ◽  
Clinical Endpoints ◽  
Intensive Care Patients ◽  
Tertiary Centre

The primary objective of this study was to determine the pattern of N-Terminal pro brain natriuretic peptide (NT-pro BNP) secretion pre and post cardiac surgery and then to investigate the correlation between levels of serum NT-pro BNP and postoperative clinical and biochemical endpoints. This was a prospective observational study performed at a tertiary centre in New Zealand, examining 118 adult patients undergoing cardiac surgery. Interventions included blood samples for NT-Pro BNP and troponin-T taken 48 hours prior to operation and 12, 36 and 72 hours postoperatively. The plasma NT-pro BNP levels increased fourfold postoperatively, to plateau at 36 to 72 hours. Preoperative NT-pro BNP levels correlated with ventilation time (r=0.46), length of stay in intensive care unit (r=0.59), total perioperative noradrenaline dose (r=0.55), but not with postoperative atrial fibrillation or mortality. Using multivariate analysis, serum NT-pro BNP levels at 36 hours were associated with increased noradrenaline dose (P=0.001), decreased preoperative ejection fraction (EF) Group (P=0.013) and elevated preoperative NT-pro BNP (P <0.001). Factors not associated with NT-pro BNP levels at 36 hours include the operation type, bypass and cross-clamp times, use of milrinone and troponin-T. We conclude that NT-pro BNP levels increased markedly after cardiac surgery and that high preoperative NT-pro BNP levels are associated with a slow postoperative recovery, but do not predict the occurrence of postoperative atrial fibrillation or mortality. Myocardial ischaemia is an unlikely cause of the NT-pro BNP elevation, because no correlation existed between troponin-T and NT-pro BNP levels.

scholarly journals Plasma 25-hydroxyvitamin D2 and D3 levels and incidence of postoperative atrial fibrillation

2016 ◽  
Vol 5 ◽  
Author(s):  
G. V. Skuladottir ◽  
A. Cohen ◽  
D. O. Arnar ◽  
D. M. Hougaard ◽  
B. Torfason ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Plasma Levels ◽  
Heart Surgery ◽  
Univariate Analysis ◽  
Open Heart Surgery ◽  
Postoperative Atrial Fibrillation ◽  
Valvular Surgery ◽  
Increased Risk ◽  
Significant Difference ◽  
Median Plasma

AbstractLow circulating levels of total 25-hydroxyvitamin D (25(OH)D) have been associated with an increased risk of adverse effects after cardiac surgery. The metabolites, 25(OH)D2 and 25(OH)D3, provide a good index of vitamin D status. In this study, we examined the association between preoperative plasma levels of total 25(OH)D, 25(OH)D2 and 25(OH)D3 and the risk of postoperative atrial fibrillation (POAF) following open heart surgery. The levels of plasma 25(OH)D2 and 25(OH)D3 in 118 patients, who underwent coronary artery bypass grafting and/or valvular surgery, were measured immediately prior to surgery and on postoperative day 3 by liquid chromatography–tandem mass spectrometry. Patients who developed POAF had higher median plasma levels of 25(OH)D2 than those who remained in sinus rhythm (SR) (P = 0·003), but no significant difference was noted in levels of 25(OH)D3 or total 25(OH)D between the two groups (P > 0·05). By univariate analysis, patients with total 25(OH)D and 25(OH)D2 levels above the median had higher frequency of POAF (P < 0·05) and the incidence of POAF increased significantly with each higher quartile of preoperative plasma levels of 25(OH)D2 (P = 0·001), an association that was independent of confounding factors. In both the SR and POAF groups, the median plasma levels of 25(OH)D2, 25(OH)D3 and total 25(OH)D were lower (P < 0·05) on the third postoperative day compared with preoperatively. Our findings demonstrate that higher plasma levels of 25(OH)D2 are associated with increased risk of POAF, while this is not the case for 25(OH)D3 or total 25(OH)D. The reason for these discrepant results is not clear but warrants further study.

Prophylactic Effects of Metoprolol on the Prevention of Atrial Fibrillation after Cardiac Surgery Are Dose Dependent

2014 ◽  
Vol 17 (1) ◽  
pp. 54 ◽  
Author(s):  
Nan Cheng ◽  
Changqing Gao
Keyword(s):  
Atrial Fibrillation ◽  
Cardiac Surgery ◽  
Heart Surgery ◽  
Beta Blockers ◽  
Open Heart Surgery ◽  
Asian Patients ◽  
Different Response ◽  
Prolonged Hospital ◽  
Dose Dependent ◽  
Study Dose

Atrial fibrillation (AF) is one of the most common complications after cardiac surgery. Many studies have reported an incidence of 20%-40% in patients undergoing open heart surgery, and the peak incidence usually occurs between the postoperative days [Fuller 1989; Aranki 1996; Svedjeholm 2000; Maisel 2001]. AF is commonly self-limited and rarely results in postoperative death. However, postoperative AF (POAF) is often associated with complications, including stroke, heart failure, prolonged hospital stay, and increased costs [Maisel 2001; Bramer 2010]. Many pharmacological methods have been used to prevent this complication, and beta-blockers, which have been investigated in several studies, have demonstrated effectiveness [Ali 1997; Connolly 2003; Crystal 2004; Halonen 2006; Imren 2007]. There is currently a consensus in the use of beta-blockers for the prevention of POAF. However, whether the effect of beta-blockers on POAF is dose dependent has not been widely studied [Coleman 2004; Lucio 2004]. In addition, patients with different racial backgrounds have a different response to metoprolol based on body shape. In addition, the CYP2D6 genotypes are different among white and Asian patients. In this study dose-dependent prophylactic effects of beta-blockers, which were obtained in a single center.

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