Echocardiographic Predictors of Atrial Fibrillation after Coronary Artery Bypass Grafting

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Karim Mounir Kame ◽  
Bassam Sobhy Hennawy ◽  
Ahmed Mohammed Abd-Elsalam ◽  
Ahmed Mohammed Onsy
Keyword(s):  
Atrial Fibrillation ◽  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Speckle Tracking ◽  
Artery Bypass ◽  
P Value ◽  
Left Main ◽  
Tracking Technique ◽  
Group I ◽  
Significant Difference

Abstract Background Postoperative atrial fibrillation (POAF) complicates 20–40% of cardiac surgical procedures and 10–20% of non-cardiac thoracic operations. Typical features include onset at 2–4 days postoperatively, episodes that are often fleeting and a self-limited time course. Associated adverse consequences of POAF include hemodynamic instability, increased risk of stroke, lengthened hospital and intensive care unit stays and greater costs (Dobrev et al., 2019). Aim The aim of this work is to detect the echo-cardio graphic parameters for prediction of post-operative atrial fibrillation in patients with ischemic heart disease undergoing isolated coronary artery bypass graft. Methods One hundred patients with multivessel disease for CABG were prospectively enrolled; all of them were in sinus rhythm at the moment of enrollment. LA maximal volume, LV ejection fraction, LVESV &LVEDV and TDI were assessed. Moreover, LA strain and Left Ventricular Global Longitudinal Strain % were analyzed by speckle tracking technique. Patients were followed up for 1 week after surgery in order to identify occurrence of atrial fibrillation. Results We found a statistically significant difference between patients undergoing CABG who are older in age with mean ± SD 64.455 ± 6.254 in group I (AF) vs. 54.577 ± 6.710 in group II with p value <0.001*, we found also that patients undergoing CABG with POAF (group I) 50 % of them had left main diseases vs. 23% in group II (NSR) with other lesions (RCA&LCX), p value = 0.014*. Conclusions There is no significant difference between the two groups regarding conventional echo parameters, TDI & by speckle tracking technique (LA strain & LVGLS %). However, patients who developed POAF were older, & left main lesions are more likely to have left main lesions.

scholarly journals Effect of preoperative atrial fibrillation on long-term results after Off Pump Coronary Artery Bypass

2021 ◽  
Vol 38 (6) ◽  
pp. 5-15
Author(s):  
Soslan T. Enginoev ◽  
Dmitriy A. Kondratiev ◽  
Gasan M. Magomedov ◽  
Tamara K. Rashidova ◽  
Bakytbek K. Kadyraliev ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Coronary Artery ◽  
Sinus Rhythm ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Long Term Results ◽  
Off Pump ◽  
Group I ◽  
Pump Coronary Artery Bypass

Objective. To study the effect of preoperative atrial fibrillation (AF) on the risk of stroke and long-term mortality after Off Pump Coronary Artery Bypass (OPCAB). Materials and methods. A retrospective analysis of the results of OPCAB in 212 patients with coronary artery disease (CAD), who were operated on from May 2009 to November 2013, was carried out. After propensity score matching, patients were divided into 2 groups: Group I 82 patients with sinus rhythm (SR) before surgery, Group II (control) 102 patients with AF before surgery. The average age of the included patients was 61 6.7 years, with 95 % CI: 6062. Fifty-four (29.3 %) patients were over 65 years of age. There were 162 men (88 %) and 22 women (12 %). The median follow-up was 93.5 (66.7102.0) months. Results. The time spent in the clinic was statistically significantly shorter in the SR group than in the AF group (10 (911) and 14 (1116) hours, respectively, p 0.001). There was no statistically significant difference in the number of perioperative myocardial infarctions (in the group with SR it occurred in 1 (1.2 %) patient, in the group with AF 2 (2 %), p = 0.7), strokes (in the group with SR 1 (1.2 %), in the group with AF 3 (2.9 %), p = 0.6), as well as a 30-day mortality (in the group with SR it was 0 %, in the group with AF 3 (2.9 %), p = 0.2). In the long-term postoperative period, there were statistically significantly fewer strokes in the group with SR than in the group with AF (in the group with SR, the 10-year stroke freedom was 88.8 %, and in the group with AF 71.8 %, p = 0.018), and also better long-term survival in the group with sinus rhythm (in the group with SR, the 10-year survival rate was 79 %, in the group with AF 63.9 %, p = 0.016). Conclusions. In the group with preoperative AF, the frequency of distant strokes and deaths is higher than in patients with sinus rhythm.

scholarly journals Prophylactic effect of Amiodarone and in combination with Vitamin C in reducing atrial fibrillation after coronary artery bypass

2021 ◽  
Author(s):  
Alireza Kamali ◽  
Samira Yavari ◽  
Bijan Yazdi ◽  
Alireza Rostami
Keyword(s):  
Atrial Fibrillation ◽  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Vitamin C ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Prophylactic Effect ◽  
Artery Bypass Grafting ◽  
Significant Difference

Atrial fibrillation (AF) is the most common arrhythmia following cardiac surgery, leading to hemodynamic impairment and increased mortality and morbidity after coronary artery bypass grafting (CABG) and increases hospitalization. Due to the antioxidant and anti-inflammatory effects of vitamin C as well as the antiarrhythmic effect of amiodarone in reducing the incidence of atrial fibrillation after coronary artery bypass grafting, we decided to compare and evaluate the prophylactic effect of amiodarone alone and in combination with vitamin C in controlling this complication. In this double-blind clinical trial, patients were divided into two equal groups of amiodarone (300 mg amiodarone bolus during 20-30 minutes) and amiodarone + vitamin C (150 mg amiodarone and 2g vitamin C combination). Each group included 42 patients. All data were analyzed by SPSS 19 software and statistical tests of ANOVA, Chi-square and Repeated Measure. There was a significant difference between the two groups of amiodarone and amiodarone+vitamin C (p-value = 0.01) and the mean incidence of AF in the amiodarone +vitamin C group was significantly lower than that of amiodarone alone. Other arrhythmias were also lower in the amiodarone +vitamin C group than in the amiodarone group alone. The use offibrillation after CABG compared with prophylactic amiodarone alone, but did not have a significant effect on decreasing ICU stay(discharge) and duration of hospitalization.

scholarly journals Assessment of Bipolar Radiofrequency Ablation Combined with Coronary Artery Bypass Surgery for Management of Atrial Fibrillation in Cardiac Patients

2020 ◽  
Vol 23 (6) ◽  
pp. E826-E832
Author(s):  
Hamdy Singab
Keyword(s):  
Atrial Fibrillation ◽  
Coronary Artery ◽  
Radiofrequency Ablation ◽  
Sinus Rhythm ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Nyha Class ◽  
Bipolar Radiofrequency ◽  
Group I ◽  
Group Ii

Background: Atrial fibrillation (AF) is a common problem in patients undergoing coronary artery bypass graft (CABG). For AF ablation, bipolar radiofrequency ablation (BRA) achieves complete transmural ablation lines and reduces the risk of treatment failure. We analyzed the efficacy of BRA for sinus rhythm restoration in patients with AF undergoing CABG. Methods: This prospective study included patients with permanent or paroxysmal AF scheduled to undergo BRA combined with CABG in our institution from May 2014 to June 2020. After discharge from hospital, all patients were seen every 6 months over 5 years to evaluate survival, sinus rhythm restoration, and New York Heart Association (NYHA) class. Results: We enrolled 168 patients, 97 (57.7%) with permanent AF (group I) and 71 (42.3%) with paroxysmal AF (group II) at 60 months. We found that group II patients had better sinus rhythm restoration rates after BRA with CABG than group I patients (P = .005). Overall mortality at 60 months was significantly lower in group II patients (2 [2.8%]) than patients in group I (14 [14.4%]; P = .01). The survival rate was significantly higher in group II than in group I (94% versus 72%; P = .0003) as shown by Kaplan–Meier analysis. The 95% confidence interval of the Cox hazards survival regression ratio was significantly different between groups (0.1792 [0.04069 to 0.7896]; P = .006). Long-term AF (>3 years) before BRA with CABG and permanent AF type were identified as predictors of post-BRA recurrent AF (P = .0001 and P = .005, respectively). NYHA class improved significantly at 60 months compared with baseline (P < .0001). Conclusions: This study identified preoperative AF type and duration as predictors of the success of BRA combined with CABG.

Comparison of Early Outcomes in Del Nido Cardioplegia Versus Conventional Cardioplegia in Term of MP in Patients

2021 ◽  
Vol 15 (12) ◽  
pp. 3373-3374
Author(s):  
Syed Sardar Rahim ◽  
Ahmad Kamran Khan ◽  
Malik Salman ◽  
Furqan Yaqub Pannu ◽  
Bilal Ahmed ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Coronary Artery Bypass ◽  
Troponin I ◽  
Artery Bypass ◽  
P Value ◽  
Bypass Grafting ◽  
Artery Bypass Grafting ◽  
Significant Difference ◽  
The Mean

Objective: To compare early outcomes in antegrade conventional crystalloid cardioplegia with Del Nido (DN) cardioplegia in term of myocardial protection in patients undergoing CABG. Methodology: All the patients undergoing Coronary artery bypass grafting surgery were enrolled in this study after informed consent. Preoperative, intra-operative and postoperative variables were entered in the pre-designed proforma and patients were followed to compare early outcomes in Del-Nido versus Conventional Cardioplegia. Results: The mean age of the patients in Del Nido group was 54.61 ± 9.129 whereas the mean age of the patients in Conventional Cardioplegia group was 53.91 ± 10.39. There were 50(71.43%) males and 20(28.57%) females in Del-Nido group as compare with Conventional group 52(74.29%) males and 18(25.71%) females in this study. The mean cardioplegia volume given to Del Nido and Conventional Cardioplegia group as (1271.43 ± 447.91 vs 2142.86 ± 584.48 (ml/min) with p-value is <0.005 which shows there is a significant difference of Cardioplegia volume given to both groups. The mean cardiopulmonary bypass time (min) in Del Nido group was 116.87 ± 27.25 and in Conventional Cardioplegia group 106.58 ± 29.19 and the p-value of CPB time was significant 0.004. In our data 6(8.5%) patients from Del Nido Cardioplegia Group suffered from AKI whilst in Conventional Cardioplegia Group there were 7(10%) patients who suffered from AKI. Similarly 3(4.29%) patients from Del Nido Group and 2(2.86%) patients from conventional Cardioplegia Group previously suffered from stroke. Arrhythmia is a disorder of heart that affects the rate or rhythm at which the heart beats. Its p-value is significant (0.05) which shows there is a significant difference of this disorder in both groups Conclusion: There was a significant difference in post-operative complication Arrhythmia in both groups and the need for a lower cardioplegia volume and an uninterrupted procedure are the main advantages of Del Nido (DN) cardioplegia solution, which make it superior from conventional cardioplegia. Keywords: Coronary artery Bypass grafting surgery, Del Nido Cardioplegia, Conventional Cardioplegia, CKMB, Troponin I.

scholarly journals Radiofrequency pulmonary vein isolation for the prevention of new-onset atrial fibrillation after coronary artery bypass grafting

2020 ◽  
Vol 24 (3) ◽  
pp. 80
Author(s):  
A. Sh. Revishvili ◽  
V. A. Popov ◽  
E. S. Malyshenko ◽  
G. P. Plotnikov ◽  
M. M. Anishchenko ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cardiopulmonary Bypass ◽  
Coronary Artery ◽  
Radiofrequency Ablation ◽  
Coronary Artery Bypass ◽  
Pulmonary Vein ◽  
Conflict Of Interest ◽  
Artery Bypass ◽  
Group I ◽  
New Onset

<p><strong>Aim.</strong> To evaluate the in-hospital results of the epicardial bipolar radiofrequency ablation of the pulmonary vein in the<br />prevention of new-onset postoperative atrial fibrillation (POAF) in coronary artery disease (CAD) patients undergoing coronary artery bypass graft (CABG) surgery in a pilot randomised multi-centre controlled Pulmonary Vein Ablation (PULVAB).</p><p><strong>Methods.</strong> The pilot study was conducted for the organisation of a multi-centre randomised PULVAB trial. We enrolled 63 CAD patients without a history of AF. The inclusion criterion was CAD demanding CABG; the exclusion criteria were as follows: AF history, antiarrhythmic therapy in anamnesis, significant heart valve disease, severe renal failure and decompensating diabetes mellitus. The patients were randomised into 2 groups. Group I comprised 34 patients who underwent CABG alone, and Group II had 29 patients who underwent CABG combined with radiofrequency ablation (RFA) as the initial tool for POAF prevention. All the procedures were performed by a single surgical team using standardised anaesthetic and perfusion support.</p><p><strong>Results.</strong> There was no in-hospital mortality in either group. There were differences in the duration of the intervention,<br />cardiopulmonary bypass time and the aorta clamping time between groups (p &gt; 0.05). A higher incidence of POAF was<br />observed (11 %–32.4 %) in the isolated CABG group than in the CABG combined with PULVAB group (6 %–20.7 %), although the difference was not significant (p = 0.29). In most cases (91 %), AF occurred on the second to third postoperative day, irrespective of the observation group.</p><p><strong>Conclusion.</strong> The combination of CABG and RFA does not complicate the operation and does not increase the duration of the surgery or time of cardiopulmonary bypass. There were no significant differences in the postoperative course or the incidence and structure of complications between the groups. This may indicate the safety of our method. The positive tendency of POAF-cases decrease after preventive epicardial RFA observed in the present study allows us to continue the PULVAB study to gain more statistically significant results.</p><p><strong>Clin.Trials.gov Identifier:</strong> NCT03857711</p><p>Received 20 February 2020. Revised 29 June 2020. Accepted 2 July 2020.</p><p><strong>Funding:</strong> The study did not have sponsorship.</p><p><strong>Conflict of interest:</strong> Authors declare no conflict of interest.</p><p><strong>Author contributions</strong><br />Conception and design: A.Sh. Revishvili, V.A. Popov<br />Data collection and analysis: M.M. Anishchenko, E.S. Malyshenko, N.V. Popova<br />Statistical analysis: M.M. Anishchenko<br />Drafting the article: G.P. Plotnikov, M.M. Anishchenko<br />Critical revision of the article: A.Sh. Revishvili, V.A. Popov<br />Final approval of the version to be published: A.Sh. Revishvili, V.A. Popov, E.S. Malyshenko, G.P. Plotnikov, M.M. Anishchenko, N.V. Popova</p>

scholarly journals Intravenous ibutilide versus intravenous amiodarone for post-operative management of atrial fibrillation following coronary artery bypass grafting: a prospective randomized controlled double blinded trial

2021 ◽  
Vol 10 (1) ◽  
pp. 98
Author(s):  
Ankur Gandhi ◽  
Aradhaya Verma ◽  
Aditya Sharma ◽  
Sanjay Gandhi ◽  
Mohammed Abdul Salman ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Controlled Study ◽  
Anesthetic Technique ◽  
Bypass Grafting ◽  
Artery Bypass Grafting ◽  
Group I

Background: Increased incidence of post-operative atrial fibrillation (POAF) is responsible for more post-operative complications, length of hospital stay and subsequent higher costs of hospitalization. This study was done to compare the efficacy and safety of ibutilide versus amiodarone for treatment of POAF following coronary artery bypass grafting (CABG).Methods: In this prospective, randomized, double blind controlled study, 60 patients posted for CABG developing POAF, divided randomly into 30 patients each in groups A and group I. Group A received IV amiodarone at 3 mg/kg over 20 minutes and group I received IV ibutilide at 0.01 mg/kg over 10 minutes (weight <60 kg) or 1 mg over 10 minutes (weight >60 kg). Patients underwent standard anesthetic technique and monitoring for CABG. All the demographic data, hemodynamic data were recorded in a structured manner.Results: Ibutilide showed significantly faster resolution of AF at 12.47±5.3 versus 22.9±7.68 minutes by amiodarone (p=0.000). Ibutilide was found to have significantly higher incidences of recurrence at 23.3% versus 0% by amiodarone (p=0.0048). Ibutilide showed significantly lesser hypotension 0% versus 26.67% with amiodarone (p=0.002).Conclusions: This study concluded that ibutilide was found to be better suited to treat POAF patients, who underwent CABG; due to its early and efficient resolution and reduced risk of hypotension.

scholarly journals Strain and strain rate echocardiographic imaging predict occurrence of atrial fibrillation in post-coronary artery bypass grafting patients

2021 ◽  
Vol 73 (1) ◽  
Author(s):  
Gomaa Abdelrazek ◽  
Kareem Mandour ◽  
Mohammad Osama ◽  
Khaled Elkhashab
Keyword(s):  
Atrial Fibrillation ◽  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Strain Rate ◽  
Coronary Artery Bypass ◽  
Left Atrial ◽  
Speckle Tracking ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Diastolic Strain Rate

Abstract Background Atrial fibrillation (AF) occurs very frequently after coronary artery bypass grafting (CABG); it occurs in about 20–edictors can be used for the dedicatio40% of patients. It is associated with several adverse events. This study aimed to extrapolate a predictor for postoperative atrial fibrillation (POAF) occurrence which is reproducible and simple to be a part of routine echocardiography screening before CABG. This study included 89 patients scheduled for isolated coronary artery bypass surgery. History, clinical examination, and complete 2D echocardiography with LA speckle tracking analysis were done preoperatively. Patients were then followed up post-surgery for incidence of AF till discharge from the hospital. The patients were divided into 2 groups according to POAF occurrence. Results Patients who developed postoperative AF had older age (P = 0.0032) and longer hospital stay (P = 0.021) and higher stroke incidence but statistically non-significant (14.3% vs 3.3%). The POAF patients showed less peak atrial longitudinal strain (PALS) value than non-POAF patients. The left atrial strain rate values showed a significant difference with the lower left atrial systolic strain rate and less negative (higher) early diastolic strain rate and late diastolic strain rate. After multivariate logistic regression analysis, the independent predictors for POAF were PALS (OR 0.770, 95% CI 0.627–0.946), late LA diastolic strain rate (LASRa) (OR 3.476, 95% CI 1.207–12.186), and age (OR 1.181, 95% CI 1.011–1.379). Conclusion Preoperative LA global strain assessed by 2D speckle tracking analysis could be helpful as a predictor for AF post-CABG surgery, and identification of these patients may reduce its morbidity and mortality. The study suggested PALS value less than 29.8 to be a predictor for the occurrence of POAF.

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