Djaiani George, Phillips-Bute Barbara, Podgoreanu Mihai, Messier Robert H, Mathew Joseph P, Clements Fiona, Newman Mark F
Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina, USA.
Anesth Analg. 2004 Mar;98(3):585-9, table of contents. doi: 10.1213/01.ane.0000099721.67426.de.
Atrial fibrillation (AF) is associated with considerable morbidity and increased resource utilization after coronary artery bypass graft surgery. In this study, we sought to determine whether patent foramen ovale (PFO) and atrial septal aneurysm are associated with an increased risk of postoperative AF in this patient population. We performed a database study on 1008 patients undergoing primary coronary artery bypass graft surgery. All patients were assessed for the development of postoperative AF from the day of surgery to hospital discharge. Atrial septal defects were identified during comprehensive intraoperative transesophageal echocardiographic examination. Postoperative AF was present in 124 (12.3%) patients. Patients with AF were significantly older and had a more frequent incidence of preoperative congestive heart failure, longer cross-clamp time, and prolonged hospital length of stay. PFO was present in 72 (7.1%) and atrial septal aneurysm in 23 (2.3%) patients. In these patients, postoperative AF was present in 14 (19.4%) patients with PFO and 8 (34.8%) patients with atrial septal aneurysm. Multivariate logistic regression analysis identified that PFO (odds ratio [OR], 1.95; 1.007-3.778; P = 0.047), age (OR, 1.03; 1.015-1.053; P = 0.0004), and history of congestive heart failure (OR, 2.55; 1.671-3.900; P < 0.0001) were predictive of postoperative AF.
The presence of patent foramen ovale is associated with new-onset postoperative atrial fibrillation after coronary artery bypass graft surgery. This finding requires further validation in future prospective trials.
心房颤动（AF）与冠状动脉旁路移植术后的相当高的发病率及资源利用增加有关。在本研究中，我们试图确定卵圆孔未闭（PFO）和房间隔瘤是否与该患者群体术后AF风险增加相关。我们对1008例行初次冠状动脉旁路移植手术的患者进行了数据库研究。所有患者从手术日至出院均评估术后AF的发生情况。在全面的术中经食管超声心动图检查中识别房间隔缺损。124例（12.3%）患者发生术后AF。发生AF的患者年龄显著更大，术前充血性心力衰竭发生率更高，体外循环时间更长，住院时间延长。72例（7.1%）患者存在PFO，23例（2.3%）患者存在房间隔瘤。在这些患者中，14例（19.4%）PFO患者和8例（34.8%）房间隔瘤患者发生术后AF。多因素逻辑回归分析确定PFO（比值比[OR]，1.95；1.007 - 3.778；P = 0.047）、年龄（OR，1.03；1.015 - 1.053；P = 0.0004）和充血性心力衰竭病史（OR，2.55；1.671 - 3.900；P < 0.0001）可预测术后AF。
卵圆孔未闭与冠状动脉旁路移植术后新发的术后心房颤动有关。这一发现需要在未来的前瞻性试验中进一步验证。
