1st Clinical Department of Cardiology, Swietokrzyskie Centre of Cardiology, Kielce, Poland.
Department of Cardiosurgery, Swietokrzyskie Centre of Cardiology, Kielce, Poland
Kardiol Pol. 2018;76(1):195-201. doi: 10.5603/KP.a2017.0203. Epub 2017 Nov 23.
Post-operative atrial fibrillation (POAF) is the most common cardiac arrhythmia occurring after coronary artery bypass grafting (CABG). Arrhythmia leads to prolonged hospitalisation and may have an impact on both short-term and long-term prognoses.
The aim of this paper was to evaluate the incidence of POAF in patients after CABG as well as to identify its predictors.
The study was performed on 791 patients (selected from a group of 1031 patients who underwent CABG in the Clinical Department of Cardiology in the years 2009-2011) who did not suffer from atrial fibrillation (AF) prior to isolated CABG. Data on co-existing diseases, as well as data collected at the time of surgery and in the post-operative period, were evaluated.
The average age of patients in the examined group was 64.6 ± 9.1 years. Emergency CABG was performed on 38% of patients, whereas 75.1% of patients underwent CABG with the use of extracorporeal circulation. Based on the incidence of POAF, the post-CABG patients were classified into a POAF(+) group that comprised 166 (21%) patients, and a POAF(-) group involving 625 (79%) patients. The first occurrence of arrhythmia during the first three days after surgery was observed in 76.5% of patients. The average age of POAF(+) and POAF(-) patients was 68.7 ± 8.8 years and 63.5 ± 8.9 years, respectively (p < 0.0001). The respective incidence rates of co-existing diseases in patients with POAF and those without POAF were as follows: arterial hypertension, 80.1% vs. 75.8% (p = 0.29); heart failure, 18.7% vs. 21.1% (p = 0.56); type 2 diabetes, 24.1% vs. 26.2% (p = 0.64). Stable angina pectoris was diagnosed in 22.3% of patients with POAF and 15% of patients without POAF (p = 0.034). The following conditions were more frequently observed in patients with POAF compared with those without POAF: low cardiac output syndrome, 28.9% vs. 14.2% (p < 0.0001) and cardiac tamponade, 9% vs. 4.6% (p = 0.044), respectively. Red blood cell transfusions were performed more often in patients with POAF compared to those without POAF (70.5% vs. 55.7%, respectively, p = 0.0008). Multivariate analysis revealed the following potential predictors of POAF: age ≥ 70 years (HR 2.3), preoperative stable angina pectoris (HR 1.7), and post-CABG low cardiac output syndrome (HR 1.8).
POAF was diagnosed in 21% of post-CABG patients, and the major predictors were: age ≥ 70 years, preoperative stable angina, as well as low cardiac output syndrome following CABG.
术后心房颤动（POAF）是冠状动脉旁路移植术（CABG）后最常见的心律失常。心律失常导致住院时间延长，并可能对短期和长期预后产生影响。
本文旨在评估 CABG 后 POAF 的发生率，并确定其预测因素。
本研究纳入了 791 名（选自 2009 年至 2011 年在心脏病学临床科接受 CABG 的 1031 名患者中的一组）在接受单纯 CABG 前未患有心房颤动（AF）的患者。评估了合并症的数据，以及手术时和术后收集的数据。
在接受检查的患者中，平均年龄为 64.6±9.1 岁。38%的患者接受了急诊 CABG，而 75.1%的患者接受了体外循环下的 CABG。根据 POAF 的发生率，将 CABG 后的患者分为 POAF(+)组（包括 166 例[21%]患者）和 POAF(-)组（包括 625 例[79%]患者）。在手术后的头三天内，76.5%的患者首次出现心律失常。POAF(+)和 POAF(-)患者的平均年龄分别为 68.7±8.8 岁和 63.5±8.9 岁（p<0.0001）。POAF 和非 POAF 患者的合并症发生率分别为：动脉高血压，80.1%比 75.8%（p=0.29）；心力衰竭，18.7%比 21.1%（p=0.56）；2 型糖尿病，24.1%比 26.2%（p=0.64）。POAF 患者中稳定型心绞痛的诊断率为 22.3%，而非 POAF 患者为 15%（p=0.034）。与非 POAF 患者相比，POAF 患者更常出现以下情况：低心输出综合征，28.9%比 14.2%（p<0.0001）；心脏压塞，9%比 4.6%（p=0.044）。与非 POAF 患者相比，POAF 患者更常接受红细胞输注（分别为 70.5%和 55.7%，p=0.0008）。多变量分析显示 POAF 的潜在预测因素如下：年龄≥70 岁（HR 2.3）、术前稳定型心绞痛（HR 1.7）和 CABG 后低心输出综合征（HR 1.8）。
CABG 后 POAF 的诊断率为 21%，主要预测因素为：年龄≥70 岁、术前稳定型心绞痛以及 CABG 后低心输出综合征。
