Leitch J W, Thomson D, Baird D K, Harris P J
Department of Cardiology Surgery, Royal Prince Alfred Hospital, Camperdown, Sydney, Australia.
J Thorac Cardiovasc Surg. 1990 Sep;100(3):338-42.
The purpose of this study was to identify factors associated with atrial fibrillation and flutter after coronary artery bypass grafting. The study group consisted of a consecutive series of 5807 patients who underwent coronary artery bypass grafting alone and who were in sinus rhythm preoperatively. Atrial fibrillation and flutter were identified during continuous monitoring or by clinical symptoms and signs; they occurred in 17.2% of the patients. The prevalence of atrial fibrillation and flutter was directly related to age at operation, varying from 3.7% in patients aged less than 40 years to 27.7% in patients aged 70 and over. In a multivariate analysis, age remained the most important independent predictor of atrial fibrillation and flutter (p less than 0.001). Other independent predictors of atrial fibrillation and flutter were chronic airflow limitation (p = 0.006), preoperative beta-adrenergic blockers (p = 0.011), and chronic renal failure (p = 0.04). Extent of coronary disease at catheterization, history of a previous myocardial infarction, heart size on chest x-ray film, and all operative factors measured, apart from year of operation, were unassociated with atrial fibrillation and flutter. Thus atrial arrhythmias after coronary artery bypass operations are most strongly related to advanced age and are unassociated with preoperative left ventricular function and extent of coronary disease.
本研究的目的是确定冠状动脉搭桥术后与心房颤动和扑动相关的因素。研究组由连续5807例仅接受冠状动脉搭桥手术且术前为窦性心律的患者组成。通过连续监测或临床症状及体征确定心房颤动和扑动；其发生率为17.2%。心房颤动和扑动的患病率与手术年龄直接相关，年龄小于40岁的患者中发生率为3.7%，70岁及以上患者中为27.7%。在多变量分析中，年龄仍然是心房颤动和扑动最重要的独立预测因素（p<0.001）。心房颤动和扑动的其他独立预测因素为慢性气流受限（p = 0.006）、术前β受体阻滞剂（p = 0.011）和慢性肾衰竭（p = 0.04）。导管检查时冠状动脉疾病的程度、既往心肌梗死病史、胸部X线片上的心脏大小以及除手术年份外所测量的所有手术因素，均与心房颤动和扑动无关。因此，冠状动脉搭桥术后的房性心律失常与高龄关系最为密切，与术前左心室功能和冠状动脉疾病程度无关。
