Kalus James S, White C Michael, Caron Michael F, Coleman Craig I, Takata Hiroyoshi, Kluger Jeffrey
College of Medicine, University of Connecticut, Hartford Hospital Department of Pharmacy, 06102, USA.
Ann Thorac Surg. 2004 Apr;77(4):1288-92. doi: 10.1016/j.athoracsur.2003.09.050.
Atrial fibrillation is a common complication of cardiothoracic surgery (coronary artery bypass graft surgery or cardiac valve repair or replacement). Although predictors of postoperative atrial fibrillation have been explored in patients not receiving prophylactic antiarrhythmic therapy, independent predictors of postoperative atrial fibrillation in patients receiving prophylactic amiodarone have not been elucidated.
This was a substudy of a clinical trial evaluating the efficacy of an amiodarone regimen or an atrial-septal pacing strategy on the occurrence of postoperative atrial fibrillation. The association between the occurrence of postoperative atrial fibrillation and preoperative, intraoperative, and postoperative data from the total study population and the amiodarone and placebo subpopulations were explored using multiple logistic regression analysis.
The following clinical factors were independent predictors of postoperative atrial fibrillation in the total population: age (p < 0.001), history of atrial fibrillation (p = 0.021), diabetes mellitus (p = 0.008), and high-dose postoperative nonsteroidal antiinflammatory drug use (p = 0.038). Age (p = 0.016), history of mitral regurgitation (p = 0.029), heart failure (p = 0.010), and postoperative nonsteroidal antiinflammatory drug use (p = 0.038) were independent predictors when amiodarone was used, and age was the only predictor of postoperative atrial fibrillation (p = 0.024) among patients treated with placebo.
This subanalysis demonstrates some novel predictors of postoperative atrial fibrillation, including diabetes mellitus and postoperative nonsteroidal antiinflammatory drug use. We have also demonstrated that predictors of atrial fibrillation differ when prophylactic amiodarone is used.
心房颤动是心胸外科手术（冠状动脉搭桥手术或心脏瓣膜修复或置换）的常见并发症。尽管在未接受预防性抗心律失常治疗的患者中已对术后心房颤动的预测因素进行了探索，但在接受预防性胺碘酮治疗的患者中，术后心房颤动的独立预测因素尚未阐明。
这是一项临床试验的子研究，评估胺碘酮方案或房间隔起搏策略对术后心房颤动发生的疗效。使用多元逻辑回归分析探讨了术后心房颤动的发生与整个研究人群以及胺碘酮和安慰剂亚组的术前、术中和术后数据之间的关联。
以下临床因素是总体人群中术后心房颤动的独立预测因素：年龄（p < 0.001）、心房颤动病史（p = 0.021）、糖尿病（p = 0.008）以及术后高剂量使用非甾体抗炎药（p = 0.038）。使用胺碘酮时，年龄（p = 0.016）、二尖瓣反流病史（p = 0.029）、心力衰竭（p = 0.010）以及术后使用非甾体抗炎药（p = 0.038）是独立预测因素，而在接受安慰剂治疗的患者中，年龄是术后心房颤动的唯一预测因素（p = 0.024）。
该亚组分析显示了一些术后心房颤动的新预测因素，包括糖尿病和术后使用非甾体抗炎药。我们还证明，使用预防性胺碘酮时，心房颤动的预测因素有所不同。
