Abstract
BackgroundAtrial fibrillation (AF) occurs in about 27% to 40% of post cardiac surgery patients. AF following coronary artery bypass graft surgery (CABG) is associated with a two-fold increase in morbidity and mortality. Various demographic risk factors and medications have been studied to predict the occurrence of this arrhythmia. The role of angiotensin related medications on the occurrence of AF in CABG patients is not determined.MethodsRetrospective clinical and statistical analysis was made of all the patients who had undergone CABG surgery at Lehigh Valley Hospital during the years 2005 and 2006. Patients with chronic AF and those undergoing valvular surgery with CABG were excluded. Statistic analysis included chi-square test for categorical and student t-test for continuous variables.Results757 patients (560 males and 197 females) were studied. AF occurred in 19% of the patients. Age (70.5 vs. 65.1, p < 0.005. OR per year of age: 1.02, 95%CI: 1.018-1.023) and presence of hypertension (OR: 1.92, 95%CI: 1.086-3.140, p = 0.025) were significantly associated with occurrence of AF. Neither ARBs (OR: 0.78, 95%CI: 0.431-1.410, p = 0.41) nor ACE inhibitors (OR: 1.01, 95%CI: 0.753-1.608, p = 0.63) reduced the occurrence of post operative AF. Patients with post operative AF had a significantly longer hospital stay (9.5 +/- 5.4 days vs. 6.9 +/- 4.3 days, p = 0.001).ConclusionsAdvanced age and presence of hypertension were independent predictors of post-CABG AF. Patients with post operative AF had significantly longer hospital stay. Neither ARBs nor ACE inhibitors were associated with reduction of post-surgical AF. Further studies are needed to better delineate the role of angiotensin related medications on reduction of post-surgical AF.
Highlights
Atrial fibrillation (AF) occurs in about 27% to 40% of post cardiac surgery patients
Patients with diabetes mellitus had a higher incidence, while patients on angiotensin receptor blockers (ARBs) had a lower incidence of AF, though neither were statistically significant
Subgroup analysis of patients who are older than 65 years with hypertension and diabetes On additional subgroup analysis of these patients; no characteristic was identified with an increased occurrence of AF there was a numerically lower propensity for AF in those patients receiving ARBs, clopidogrel, aspirin, beta-blockers and smokers none of these was statistically significant (Table 3)
Summary
Atrial fibrillation (AF) occurs in about 27% to 40% of post cardiac surgery patients. AF following coronary artery bypass graft surgery (CABG) is associated with a two-fold increase in morbidity and mortality. Various demographic risk factors and medications have been studied to predict the occurrence of this arrhythmia. Atrial fibrillation (AF) occurs in about 27% to 40% of post cardiac surgery patients [1] The presence of this arrhythmia following coronary artery bypass graft surgery (CABG) is associated with a two-fold increase in cardiovascular morbidity and mortality [2]. Multiple investigations have been performed to identify the demographic risk factors, association of medications and the predictors of post operative AF, but there is no conclusive information [12]. The present study was aimed at identifying the preoperative demographic predictors and the effects of ACEI and ARBs on the occurrence of AF in patients who underwent CABG surgery
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