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.

Predictors of postoperative atrial fibrillation persisting beyond hospital discharge after coronary artery bypass grafting

Perfusion ◽  
2020 ◽  
pp. 026765912097864
Author(s):  
Aschraf El-Essawi ◽  
Ahmed Abdelhalim ◽  
Steffen Groeger ◽  
Ingo Breitenbach ◽  
Rene Brouwer ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Hospital Stay ◽  
Coronary Artery Bypass ◽  
Hospital Discharge ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Artery Bypass Grafting ◽  
Holter Monitor

Objective: Minimal invasive extracorporeal circuits (MiECC) have been associated with a significant reduction in the incidence of postoperative atrial fibrillation (AF). Nevertheless, AF remains one of the most common complications following elective primary coronary artery bypass grafting (CABG). The aim of this study was to identify the predictors of AF persisting beyond the hospital stay in elective primary CABG patients. Methods: We conducted a retrospective analysis for the predictors of AF that persisted beyond discharge between all patients who received an elective isolated CABG in our institution between 2009 and 2014. Patients with a positive history for intermittent or persistent AF were excluded from the analysis. Almost all patients were discharged to a rehabilitation facility where they stayed for 3 to 4 weeks postoperatively. At rehab approximately 91% of them received Holter monitoring at least once prior to their discharge. Results: A total of 770 patients were included in the analysis of which 763 patients survived the in-hospital stay. The incidence of AF at hospital discharge was 4.2% (32/763) while that on Holter monitor at Rehab was 1.5% (10/685). Age and the type of extracorporeal circuit (ECC) utilized were the only significant predictors for both AF at discharge ( p < 0.01 both) and on Holter monitor in rehab ( p < 0.01 and 0.02, respectively). This was also confirmed on multivariate analysis. Conclusion: Our findings show that the benefits of MiECC regarding the incidence of postoperative AF persist beyond hospital discharge. They may thus positively influence the outcomes of patients beyond the early postoperative period.

Frailty syndrome as an independent predictor of unfavorable outcome in patients undergoing coronary artery bypass grafting

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
K Krivoshapova ◽  
O.L Barbarash ◽  
E.A Wegner ◽  
N.A Terentyeva ◽  
I.I Grigorieva ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Coronary Artery Bypass ◽  
Postoperative Period ◽  
Artery Bypass ◽  
Early Postoperative Period ◽  
Bypass Grafting ◽  
Artery Bypass Grafting ◽  
Risk Of Death

Abstract Purpose To assess the prevalence of frailty in the preoperative period and to evaluate its effect on the risk of complications and adverse outcomes in patients undergoing coronary artery bypass grafting (CABG). Methods 303 patients undergoing preoperative management for elective primary CABG were recruited in the study. The study cohort was divided into three groups depending on the PRISMA-7 scores suggesting the presence or absence of frailty and the presence of prefrailty. Statistical analysis was performed using the commercially available software package STATISTICA 8.0.360.0 for Windows (StatSoft, Inc., USA) and SPSS Statistics v. 17.0.0. Results 46 (15%) patients had frailty, while 49 (16%) patients were diagnosed with prefrailty. 208 (69%) patients did not have any signs of frailty. All three groups had significant age differences, therefore only elderly patients aged of 67.0±6.5 years with frailty were allocated for subsequent analysis (prefrailty group - 62.3±7.4 years old, patients without frailty - 60.0±7.7 years, p=0.003). Patients with frailty or prefrailty more often suffered from diabetes mellitus (patients without frailty - 19.2%, prefrailty group - 30.6% and frailty group - 28.3%, p=0.05), arterial hypertension (69.2%, 93.9% and 95.7%, respectively, p&lt;0.001), atrial fibrillation or flutter (7.2%, 14.3% and 19.6%, respectively, p=0.03), chronic heart failure class 3–4 (7.2%, 10.2% and 8.7%, respectively, p=0.002), and peripheral arterial disease (22.6%, 38.8% and 58.7%, respectively, p&lt;0.001). Three groups were comparable in main clinical and demographic parameters. There were no significant differences found in the incidence of postoperative atrial fibrillation or flutter (15.9%, 8.2% and 6.5%, respectively, p=0.07) and infections (1.9%, 0% and 4.3%, respectively, p=0.640). The incidence of myocardial infarction in the intra- and early postoperative period after CABG did not differ significantly between the groups (0.5%, 2% and 0%, respectively, p=0.328) as well as the incidence of stroke (2.4%, 2% and 0%, respectively, p=0.640). Patients with frailty and prefrailty had significantly higher cerebrovascular and cardiovascular mortality compared to those without frailty (8.2%, 2.2% and 0.5%, respectively, p=0.001). Conclusion Almost 15% of patients referred to CABG suffered from frailty. The presence of prefrailty or frailty increases the risk of death in the early postoperative period after CABG. Funding Acknowledgement Type of funding source: None

Atrial fibrillation – Can HbA1c levels really predict the risk?

2021 ◽  
pp. 021849232199893
Author(s):  
Pradeep Narayan ◽  
Chandan Kumar Mandal ◽  
Rajlakshmi Das ◽  
Debasis Das ◽  
Paramita Auddya Ghorai ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Confidence Interval ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Artery Bypass Grafting ◽  
Post Operative Period ◽  
Hba1c Levels

Background Diabetes is associated with higher mortality and worse post-operative outcomes in patients undergoing coronary artery bypass grafting and HbA1c levels have consistently been reported to be associated with adverse post-operative outcomes. However, the role of HbA1c still remains unclear with regards to the occurrence of atrial fibrillation. Method Data for the patients undergoing off-pump coronary artery bypass grafting was analysed in a retrospective fashion. Patients were divided into–those with HbA1c < 6.5% and those with HbA1c ≥ 6.5% and the incidence of atrial fibrillation observed in these two groups. We also compared patient who developed atrial fibrillation in the post-operative period and compared them with those who did not. Results Of the 5259 patients included in the study HbA1c was <6.5 in 2808 (53.4%) patients and was ≥6.5 in 2451 (46.6%) patients; 623 (11.8%) patients in our study developed atrial fibrillation. Onset of atrial fibrillation in the post-operative period was seen most commonly 235 (38.3%) on between 24 and 48 h after the operation with more than half of them 338 (54.2%) occurring within the first 48 h. On multivariate analysis, HbA1c was not a risk factor for atrial fibrillation (odd’s ratio 1.144, 95% confidence interval 0.967–1.354). Only increased age (odd’s ratio 1.08; 95% confidence interval 1.069–1.091); EuroSCORE (odd’s ratio 1.073; 95% confidence interval 1.048–1.099); history of recent MI (odd’s ratio 0.768; 95% confidence interval 0.606–0.971) and peripheral vascular disease (odd’s ratio 1.667; 95% confidence interval 1.091–2.517) were found to be independently associated with increased risk of atrial fibrillation in the post-operative period. Conclusions After adjusting for confounders HbA1c levels do not independently predict risk of atrial fibrillation after off-pump coronary artery bypass grafting.

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