Abstract
BackgroundPostoperative atrial fibrillation is the most common arrhythmia seen after cardiac surgery. We aimed to determine the effect of obesity and metabolic syndrome on postoperative atrial fibrillation, whether they are independent risk factors, and their effect level. We also analyzed the effect of atrial fibrillation on postoperative complications.MethodsIn our clinic, 756 patients who underwent coronary artery bypass grafting between June 2010–September 2017 were evaluated retrospectively. Preoperatively, demographic characteristics, chronic diseases, body mass index, waist circumference measurements, and ejection fraction values of the cases were determined from file records. Perioperatively, cross-clamp and cardiopulmonary bypass times, intra-aortic balloon use, distal coronary bypass counts were determined. Postoperatively, complications, duration of intensive care unit and hospital stay, and mortality were evaluated. The patients were followed up with continuous 3-lead ECG monitorization on the postoperative first day and 12-lead ECG records once in a day on the remaining days. In the study, the first endpoint was the determination of atrial fibrillation and the second endpoint was the discharge time of the patient.ResultsThe rate of postoperative atrial fibrillation was 21.3%. Atrial fibrillation was seen in 33% of metabolic syndrome cases and in 38.5% of obese cases. Atrial fibrillation was seen in 23, 24 and 17% of cases using statin, ACE inhibitor and beta blocker, respectively. It was seen in 21% of smokers and 20% of the COPD cases. In the study, metabolic syndrome, diabetes mellitus, hypertension, and obesity, between the ages of 56–78 with Metabolic syndrome, were found to affect the development of postoperative atrial fibrillation (2.46), (2.3), (1.6), and (1.65) times, respectively. In cases with postoperative atrial fibrillation, infection and stroke were 1.45 and 8.85 times more frequent, respectively. Patients with metabolic syndrome were found to have 31% longer hospital stay, and 17% higher infection rate. In obese patients, hospitalization was 23.5% longer.ConclusionsMetabolic syndrome and obesity were found to be two independent risk factors for postoperative atrial fibrillation. If causes and mechanisms of postoperative atrial fibrillation are identified in planned cardiovascular interventions, we believe that cost of hospitalization and morbidity will be reduced.
Highlights
Postoperative atrial fibrillation is the most common arrhythmia seen after cardiac surgery
The metabolic syndrome (MS) is known as a syndrome characterized by increased abdominal obesity, increased insulin resistance, decreased high-density lipoprotein (HDL), and elevated Low-density lipoprotein
Watanabe et al demonstrated that metabolic syndrome is an independent risk factor for atrial fibrillation (AF) development even in the absence of diabetes and hypertension (HT), and is strongly associated with stroke, myocardial infarction (MI), and allcause mortality [6]
Summary
Postoperative atrial fibrillation is the most common arrhythmia seen after cardiac surgery. Kozan et al reported that in Turkey, metabolic syndrome was seen in 33.9% of the population over 20 years of age and more frequently in women [2]. These data were obtained when the upper limit of the waist circumference is 102 cm for men and 88 cm for women. Postoperative atrial fibrillation (POAF) has been reported to increase hospital admissions in the US by ~ 30 days, resulting in an additional cost of $ 18,000–19,000 and a 2 or 3-fold increase in stroke risk [5]. Watanabe et al demonstrated that metabolic syndrome is an independent risk factor for AF development even in the absence of diabetes and hypertension (HT), and is strongly associated with stroke, myocardial infarction (MI), and allcause mortality [6]
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