Melby Spencer J, George James F, Picone Desiree J, Wallace Jerald Payden, Davies James E, George David J, Kirklin James K
Division of Cardiothoracic Surgery, Department of Surgery, The University of Alabama at Birmingham, Birmingham, Ala.
Division of Cardiothoracic Surgery, Department of Surgery, The University of Alabama at Birmingham, Birmingham, Ala.
J Thorac Cardiovasc Surg. 2015 Mar;149(3):886-92. doi: 10.1016/j.jtcvs.2014.11.032. Epub 2014 Nov 21.
Multiple mechanisms may be involved in postoperative atrial fibrillation. Therefore, our objective was to determine the risk factors for postoperative atrial fibrillation as a function of time after coronary artery bypass grafting or valve surgeries to determine which risk factors might predominate at different times.
Parametric hazard functions were determined for 1583 patients and then in subgroups (coronary artery bypass grafting alone, mitral valve procedure, and aortic valve replacement +/- coronary artery bypass grafting). Multivariable risk factor analyses were performed, and the risk for postoperative atrial fibrillation was estimated.
The risk for postoperative atrial fibrillation for all patients was highest immediately postoperatively and at 48 hours. The initial peak risk declined to approximately zero within 18 hours postoperatively. A second peak occurred at 48 hours, followed by a slow decline over the following 4 to 7 days. The time intervals encompassing these peaks were termed phase I and phase II. Predominant risk factors in phase I were older age (relative risk [RR], 1.6; P = .006), longer crossclamp time (RR, 1.3; P = .001), and mitral valve procedure (RR, 2.5; P = .0001). In phase II, these were older age (RR, 3.0; P < .0001), greater weight (RR, 1.6; P < .0001), and Caucasian race (RR, 2.5; P = .006). For patients receiving a mitral valve procedure, the risk for postoperative atrial fibrillation in phase II was higher and remained elevated for as long as 9 days postoperatively in comparison with isolated coronary artery bypass grafting, for which the risk returned to near baseline by postoperative day 6.
Phase I and phase II periods are associated with distinct risk factors; therefore, it is likely that the mechanisms of postoperative atrial fibrillation change over time.
术后房颤可能涉及多种机制。因此，我们的目的是确定冠状动脉搭桥术或瓣膜手术后不同时间点的术后房颤危险因素，以确定哪些危险因素在不同时间可能占主导地位。
确定了1583例患者的参数风险函数，然后在亚组中（单纯冠状动脉搭桥术、二尖瓣手术和主动脉瓣置换术±冠状动脉搭桥术）进行。进行多变量危险因素分析，并估计术后房颤的风险。
所有患者术后房颤的风险在术后即刻和48小时时最高。最初的峰值风险在术后18小时内降至接近零。第二个峰值出现在48小时，随后在接下来的4至7天内缓慢下降。包含这些峰值的时间间隔被称为I期和II期。I期的主要危险因素是年龄较大（相对风险[RR]，1.6；P = 0.006）、体外循环时间较长（RR，1.3；P = 0.001）和二尖瓣手术（RR，2.5；P = 0.0001）。在II期，这些因素是年龄较大（RR，3.0；P < 0.0001）、体重较大（RR，1.6；P < 0.0001）和白种人（RR，2.5；P = 0.006）。对于接受二尖瓣手术的患者，与单纯冠状动脉搭桥术相比，II期术后房颤的风险更高，并且在术后长达9天内一直升高，而单纯冠状动脉搭桥术的风险在术后第6天恢复到接近基线水平。
I期和II期与不同的危险因素相关；因此，术后房颤的机制可能随时间而变化。
