Predictors of atrial fibrillation after off-pump coronary artery bypass graft surgery

• Published in: British journal of anaesthesia : BJA Vol. 98; no. 5; pp. 575 - 580
• Main Authors: Hosokawa, K., Nakajima, Y., Umenai, T., Ueno, H., Taniguchi, S., Matsukawa, T., Mizobe, T.
• Format: Journal Article
• Language: English
• Published: Oxford Elsevier Ltd 01-05-2007; Oxford University Press; Oxford Publishing Limited (England)
• Subjects: Adult; Age Factors; Aged; Aged, 80 and over; anaesthesia; anaesthesia, cardiovascular; Anesthesia; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; arrhythmia; atrial fibrillation; Atrial Fibrillation - etiology; atrial fibrillation, arrhythmia; Biological and medical sciences; Body Temperature; Cardiac Output; cardiovascular; complications; complications, perioperative; Coronary Artery Bypass, Off-Pump - adverse effects; Epidemiologic Methods; Female; Humans; Intraoperative Care - methods; Male; Medical sciences; Middle Aged; perioperative; surgery; surgery, cardiovascular; Water-Electrolyte Balance; anaesthesia, cardiovascular; complications, perioperative; atrial fibrillation, arrhythmia; surgery, cardiovascular; Arrhythmia; perioperative; surgery; Atrial fibrillation; Cardiovascular disease; cardiovascular; Coronary heart disease; Excitability disorder; cardiovascular; atrial fibrillation; Surgery; Anesthesia; Complication; Graft; arrhythmia; complications; anaesthesia
• ISSN: 0007-0912; 1471-6771
• DOI: 10.1093/bja/aem067

Postoperative atrial fibrillation (AF) is one of the most common complications after cardiothoracic surgery and is associated with an increased risk of stroke, and longer hospital stay. The pathophysiology of postoperative AF is uncertain, and its prevention remains unsatisfactory. Many previous studies have examined the predictors of AF after on-pump coronary artery bypass graft surgery (CABG), but there are few reports after off-pump CABG.
The aim of the present prospective observational study, in which 296 consecutive patients were enrolled, was to elucidate the predictors of AF after off-pump CABG. The association of perioperative factors with AF was investigated using univariate analysis. Significant variables were included into a stepwise logistic regression model to ascertain their independent influence on the occurrence of AF.
The incidence of AF was 32%. AF prolonged the time until patients were fit for discharge by 3 days (P < 0.01). Stepwise multivariate analysis identified increasing age [odds ratio (OR) 1.44 per 10-yr increase; 95% confidence interval (CI) 1.06–1.95], intraoperative average core temperature (OR 1.64; 95% CI 1.05–2.56), the average cardiac index in the intensive care unit (OR 0.37; 95% CI 0.19–0.71), and intraoperative fluid balance (OR 0.96 per 100-ml increase; 95% CI 0.93–0.99) as independent predictors of postoperative AF.
Our present findings indicate that ageing, the intraoperative fluid balance, and postoperative cardiac index are associated with the onset of AF after off-pump CABG.