Ismail Mohamed F, El-Mahrouk Ahmed F, Hamouda Tamer H, Radwan Hanan, Haneef Ali, Jamjoom Ahmed A
Cardiothoracic Surgery Department, Faculty of medicine Mansoura University, Mansoura, Egypt.
King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia.
J Cardiothorac Surg. 2017 May 23;12(1):40. doi: 10.1186/s13019-017-0609-1.
The reported incidence of AF after CABG surgery varies from 20 to 40%, with the arrhythmia usually occurring between second and fourth postoperative days. Postoperative AF after CABG was associated with greater in-hospital mortality and worse survival at long-term follow-up. Therefore, intensive attention has focused on the prevention of AF in high-risk patients. Many perioperative factors have been suggested to increase the incidence of postoperative AF after conventional CABG. In this study we are trying to examine some of these risk factors as predictors for Post-operative AF in our patients. In this study, our aim was to identify the perioperative predictors of AF in our patients who underwent Coronary Artery Bypass Grafting.
Our Patients were divided into two groups; Group A included patients who did not develop PO AF (168 patients) and Group B patients who developed PO AF (84 patients). Perioperative Data, including gender, age, demographic variables and postoperative morbidity and mortality were extracted from the medical records.
This retrospective cohort study was conducted on 252 consecutive adult patients underwent CABG, in King Faisal Specialist Hospital and Research Center in Jeddah, Saudi Arabia. The mean age for patients with PO AF was 65 years (P = .0001). Eight-three patients (49.4%) were diabetics in group A and 56 patients (66.7%) in group B (P = .0001). Patients who developed POAF had a lower ejection fraction (44.8 ± 5.7%) (P = .0001), diastolic dysfunction (P = .0001), Larger Left atrial volume (P = .0001). Bleeding requiring re-opening for exploration and Postoperative shock were identified as significant predictors for POAF. Multivariate logistic regression (odds ratio, ±95% CI, P value) was performed to identify the effect of age, preoperative heart rate, ejection fraction, postoperative bleeding, Shock, ventilator time, Sensitivity was 89.5%, specificity was 94.6%, positive predictive value was 89.5%, and negative predictive value was 94.6%.
In our study, advanced age, enlarged LA volume, low ejection fraction, combined surgeries and prolonged ventilation time were found to be predictors of atrial fibrillations after coronary artery bypass grafting.
冠状动脉旁路移植术（CABG）后房颤的报道发病率在20%至40%之间，心律失常通常发生在术后第二至四天。CABG术后房颤与更高的院内死亡率及长期随访中更差的生存率相关。因此，对高危患者预防房颤给予了密切关注。许多围手术期因素被认为会增加传统CABG术后房颤的发病率。在本研究中，我们试图检查其中一些危险因素，作为我们患者术后房颤的预测指标。在本研究中，我们的目的是确定接受冠状动脉旁路移植术患者术后房颤的围手术期预测因素。
我们的患者分为两组；A组包括未发生术后房颤的患者（168例），B组包括发生术后房颤的患者（84例）。从病历中提取围手术期数据，包括性别、年龄、人口统计学变量以及术后发病率和死亡率。
这项回顾性队列研究在沙特阿拉伯吉达法赫德国王专科医院及研究中心对252例连续接受CABG的成年患者进行。术后房颤患者的平均年龄为65岁（P = 0.0001）。A组有83例患者（49.4%）为糖尿病患者，B组有56例患者（66.7%）为糖尿病患者（P = 0.0001）。发生术后房颤的患者射血分数较低（44.8±5.7%）（P = 0.0001），存在舒张功能障碍（P = 0.0001），左心房容积较大（P = 0.0001）。需要再次开胸探查的出血及术后休克被确定为术后房颤的重要预测因素。进行多因素逻辑回归分析（比值比，±95%可信区间，P值）以确定年龄、术前心率、射血分数、术后出血、休克、呼吸机使用时间的影响，敏感度为89.5%，特异度为94.6%，阳性预测值为89.5%，阴性预测值为94.6%。
在我们的研究中，高龄、左心房容积增大、射血分数低、联合手术及通气时间延长被发现是冠状动脉旁路移植术后房颤的预测因素。
