Perioperative Risk Factors of Atrial Fibrillation Post CABG Surgeries, a Retrospective Non-Randomized Study

Abstract

Abstract Background Atrial fibrillation represents a common complication after coronary artery bypass and valvular surgery, although it is a benign arrhythmia it may contribute to the morbidity, high cost and prolonged ICU stay. Objectives The purpose of this study is to investigate and analyze the incidence and risk factors associated with postoperative atrial fibrillation (POAF) and its impact on intensive care unit (ICU) and postoperative hospital stay in patients undergoing coronary artery bypass graft surgeries (CABG) at Ain Shams University hospitals using the medical records of patients who underwent(CABG) surgeries from July 2018 to July 2019. Patients and Methods Our study was conducted in Ain Shams University hospitals from July 2018 to July 2019. This study was a retrospective non randomized on total 660 patients who undergone isolated Coronary artery bypass graft surgeries (CABG) during this period, of them we targeted 100 cases who developed POAF after surgery. Results Our results show that age, history of hypertension,smoking,history of renal impairment and recent myocardial infarction were all predictors of atrial fibrillation after cardiac surgery. POAF developed more frequent in patients who had larger left atrium diameter and lower ejection fraction. Our present results indicate that there is significant association between longer bypass and cross clamping time and development of POAF. We also found that patients who had postoperative lower serum potassium experienced more frequent POAF than who had normal potassium levels. In our study, we found that use of preoperative beta blocking drugs reduces risk of developing POAF. Early electrocardiographic ischemic postop. changes was also associated with high risk to develop POAF. No significant relation between use of intra-aortic balloon pump and development of POAF. Also, no significant relation between POAF and development of stroke or thromboembolic manifestations as POAF is usually self limiting,transient and resolves spontaneously in most of cases. Conclusion The current study found that low ejection fraction, dilated left atrium, hypertension, smoking, old age, male gender, prolonged bypass time, prolonged cross clamping time, renal impairment, previous myocardial infarction, ungrafted dominant right coronary artery, low temperatures on bypass, early ischemic changes postoperative, hypokalemia, use of adrenaline and nor adrenaline, all of these factors were a significant predictors for development of atrial fibrillation after cardiac surgery.