Tamis-Holland Jacqueline E, Kowalski Marcin, Rill Velisar, Firoozi Kamran, Steinberg Jonathan S
St. Luke's-Roosevelt Hospital Center and Columbia University, College of Physicians and Surgeons, New York, NY 10025, USA.
Ann Noninvasive Electrocardiol. 2006 Apr;11(2):139-44. doi: 10.1111/j.1542-474X.2006.00095.x.
Atrial fibrillation (AF) is the most common arrhythmia occurring in patients after coronary artery bypass surgery (CABG). The purpose of this study was to determine whether AF characteristics were independently associated with postoperative length of stay (LOS).
Two hundred ninety consecutive post-CABG patients were examined through a detailed chart review. Baseline, intraoperative, and postoperative variables and the characteristics of AF were recorded. AF episodes were divided into single episodes lasting less than 24 hours (short-lived AF) and recurrent or prolonged >or=24 hours of AF (recurrent/prolonged AF).
AF occurred in 94 (32.4%) patients. Twenty-six (27.7%) of AF patients had short-lived AF, and 68 (72.3%) of AF patients had recurrent/prolonged AF. Patients with recurrent/prolonged AF were older (P < 0.001) and more likely to have a history of prior AF (P < 0.001) relative to the other groups. Short-lived AF did not prolong LOS (7.2 +/- 2.1 days) relative to patients without AF (7.5 +/- 3.9 days), whereas recurrent/prolonged AF significantly prolonged LOS (10.4 +/- 6.1 days, P < 0.001). Multivariate analysis identified postoperative complications, recurrent/prolonged AF, age, and digoxin use as independent predictors of LOS. Recurrent/prolonged AF contributed an additional 1.1 days to LOS after adjusting for baseline clinical differences.
There are heterogenous patterns of AF after cardiac surgery. A substantial minority of AF is short-lived and isolated with no impact on LOS; however, recurrent or prolonged AF significantly affects LOS.
心房颤动（AF）是冠状动脉旁路移植术（CABG）后患者中最常见的心律失常。本研究的目的是确定AF特征是否与术后住院时间（LOS）独立相关。
通过详细的病历回顾对290例连续的CABG术后患者进行检查。记录基线、术中和术后变量以及AF的特征。AF发作分为持续时间少于24小时的单次发作（短暂性AF）和复发或持续时间≥24小时的AF（复发/持续性AF）。
94例（32.4%）患者发生AF。AF患者中26例（27.7%）为短暂性AF，68例（72.3%）为复发/持续性AF。与其他组相比，复发/持续性AF患者年龄更大（P<0.001）且更可能有既往AF病史（P<0.001）。与无AF患者（7.5±3.9天）相比，短暂性AF并未延长LOS（7.2±2.1天），而复发/持续性AF显著延长了LOS（10.4±6.1天，P<0.001）。多变量分析确定术后并发症、复发/持续性AF、年龄和地高辛使用是LOS的独立预测因素。在调整基线临床差异后，复发/持续性AF使LOS额外增加1.1天。
心脏手术后AF存在异质性模式。相当一部分AF是短暂性且孤立的，对LOS无影响；然而，复发或持续性AF显著影响LOS。
