post-CABG Atrial Fibrillation Research Articles

Atorvastatin vs Rosuvastatin in the Prevention of Cardiovascular Events: A Systematic Review

The main objective of this study is to compare any differences in the clinical response to rosuvastatin and atorvastatin in patients with cardiovascular disease. PubMed, SCOPUS, Web of Science, Science Direct, and Clinical Key were systematically searched for relevant literature. Rayyan QRCI was employed throughout this comprehensive process. We included eleven studies with a total of 6168 patients; 3231 (52.4%) patients received Atorvastatin, and 2937 (47.6%) received Rosuvastatin. Regarding ACS patients, Rosuvastatin outperformed Atorvastatin in improving laboratory indices and inflammatory markers and lowering LDL. In STEMI patients undergoing PCI, Atorvastatin was linked to less dysfunctional coronary circulation, better coronary microcirculation in patients with STEMI having primary PCI, and may enhance microvascular coronary perfusion immediately following PCI more effectively than a high-dose rosuvastatin preloading. The one study included patients undergoing CABG and did not find any differences between Atorvastatin and Rosuvastatin in preventing post-CABG atrial fibrillation (AF). These results suggest that when developing treatment plans for patients with cardiovascular disease, physicians may be able to combine atorvastatin with rosuvastatin. Cost considerations, tolerability, and patient-specific characteristics should all be taken into account during the decision-making process.

Comparison of the Efficacy of Atorvastatin and Rosuvastatin in Preventing Atrial Fibrillation after Coronary Artery Bypass Grafting: A Double-Blind Randomized Comparative Trial.

Atrial fibrillation (AF) is a supraventricular tachyarrhythmia characterized by disorganized atrial activity and subsequent mechanical atrial failure. Postoperative AF is a frequent complication of coronary artery bypass grafting (CABG). Although there is evidence of decreased AF after CABG with statin usage, information is scarce regarding a direct comparison between atorvastatin and rosuvastatin. The present study was conducted to compare the efficacy of rosuvastatin and atorvastatin in preventing post-CABG AF. The present double-blind randomized comparative clinical trial selected CABG candidates with stable ischemic heart disease or acute coronary syndromes. Atorvastatin (40 mg per day) or rosuvastatin (20 mg per day) was prescribed 1 week before surgery, and the outcomes were compared. Two-hundred patients, 100 cases in each group, completed the study. Twenty-five patients in each group were female, and the mean age was 59.30±8.42 years in the rosuvastatin group and 60.13±9.40 years in the atorvastatin group (P=0.513). The frequency of AF was 31% in the atorvastatin group and 27% in the rosuvastatin group (P=0.534). No significant differences existed between the groups concerning the length of hospital and ICU stay (P=0.333 and P=0.161) and in-hospital and 3-month mortality (P=0.315 and P=0.648). A subgroup analysis of only patients with stable ischemic heart disease could not detect a significant difference between the study groups in any of the investigated outcomes. Our logistic regression analysis showed an association only between age and the incidence of AF after CABG (OR, 1.12; 95% CI, 1.05 to 1.20; P<0.01). Rosuvastatin and atorvastatin are similar concerning the prevention of post-CABG AF, but there is a need for future well-designed multicenter studies on this topic.

Conventional and two-dimensional strain echocardiography in predicting postoperative atrial fibrillation after coronary artery bypass grafting surgery.

Atrial fibrillation (AF) is a common complication after heart surgeries. Advances in imaging technologies and an understanding of the pathophysiology of preoperative left atrial (LA) dysfunction can lead to more definitive potential therapeutic approaches. This study aimed to determine the role of conventional echocardiography and LA two-dimensional (2D) strain echocardiography in assessing LA function and predicting POAF after CABG surgery. All patients with sinus rhythm who underwent CABG surgery were enrolled. All the patients had undergone conventional echocardiography and LA 2D-strain echocardiography 24 hours before surgery. In addition to demographic, clinical, and perioperative features, electrocardiogram (ECG) and Holter monitoring were recorded. Of the 105 patients included, 85 patients (81%) were men with a mean age of 60.26±10.61 years. POAF was seen in 22.9% of patients during hospitalization, and AF duration was 10 hours (median; IQR: 2.0-19.5). AF patients had a higher LA volume index (LAVI) than patients with sinus rhythm (p=0.018). Patients with sinus rhythm had higher rates of LA reservoir (26.97±6.87 VS. 20.46±4.27, p<0.001), LA contractile (14.98±3.68 VS. 12.76±3.72, p =0.012) and LA global strain (24.28±6.57 VS. 17.71±4.11, p<0.001) than AF patients. The results of the multivariate logistic regression showed that LAVI (p=0.014) and LA global strain (p=0.027) were independent predictors of AF detection. Compared to conventional echocardiography, 2D-strain echocardiography is a more effective diagnostic method to predict the possibility of post-CABG AF.

Conventional and Two-dimensional Strain Echocardiography in Predicting Postoperative Atrial Fibrillation after Coronary Artery Bypass Grafting Surgery in Shahid Madani Hospital of Tabriz, Iran

Objectives: Atrial fibrillation (AF) is a common complication of heart surgery with favorable short- and long-term outcomes. Preoperative left atrial (LA) dysfunction may be a significant component in identifying patients at risk for postoperative atrial fibrillation (POAF) after coronary artery bypass grafting (CABG (surgery. Advances in imaging technologies and an understanding of AF pathophysiology can lead to more definitive potential therapeutic approaches. The paper has the aim to present the role of conventional echocardiography and LA two-dimensional (2D) strain. 2D Strain echocardio graphies in assessing LA function in predict POAF after CABG surgery.&#x0D; Materials and Methods: In this study, all patients with sinus rhythm who underwent CABG surgery were selected. All the patients had undergone conventional echocardiography and LA 2D-strain echocardiography 24 hours before surgery. In addition to demographic, clinical, and intraoperative features, other assessments, including electrocardiogram (ECG) and Holter monitoring, were recorded. The obtained information was recorded, and the study results were reported using descriptive statistics (mean, standard deviation, and percentage frequency). A Chi-square test was used to evaluate the qualitative variables, and a t-test was used to compare the quantitative variables. Given the multi-factorial nature of AF, univariate and multivariate methods were used to analyze the data and the effect of STRAIN. In this study, P &lt; 0.05 was considered significant.&#x0D; Results: According to the findings, 85 patients (81%) were male with a mean age of 60.26 ± 10.61 years. 50% of the patients underwent off-pump CABG surgery, and 50% underwent on-pump surgery with a mean time of 98.52 ± 22.44 minutes. POAF was seen in 22.9% of patients during hospitalization, and AF's duration was 13.85 ± 14.41 hours. AF patients had higher LA volume index (LAVI) than non-AF patients (p = 0.018). There was no significant difference between the two groups in terms of left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD), left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), left ventricular ejection fraction (LVEF), E/e, E/A,and deceleration time(DT) . Non-AF patients had higher rates of LA reservoir (26.97 ± 6.87 VS. 20.46 ± 4.27, p &lt;0.001), LA contractile (14.98 ± 3.68 VS. 12.76 ± 3.72, p =0.012) and LA global (24.28 ± 6.57 VS. 17.71 ± 4.11, p &lt;0.001) than AF patients. The results of the multivariate logistic regression showed that LAVI (p= 0.014) and LA global (p = 0.027) were significant predictors of AF detection. Thus with increasing LAVI, the probability of developing AF increases, and with decreasing LA global, this probability decreases.&#x0D; Conclusions: Compared to conventional echocardiography, 2D-strain echocardiography is a more effective diagnostic tool in predicting the possibility of post-CABG AF.

Abstract 13429: A Systematic Review and Meta-Analysis of Comparative Studies of Postoperative Atrial Fibrillation in Obstructive Sleep Apnea Patients Undergoing Coronary Artery Bypass Grafting

Background: Post-CABG Atrial Fibrillation (PCAF) is linked to higher mortality, morbidity, and healthcare costs. Obstructive Sleep Apnea (OSA) has been studied as a risk factor for PCAF in a few studies. In this study, we sought to review and analyze the association between OSA and PCAF. Methods: We systematically searched PubMed, Scopus, and EMBASE for studies on OSA as predictors of PCAF using relevant keywords through June 2022. Random effects models were used to estimate pooled rates of PCAF with subgroup analysis. I 2 statistics were used to report inter-study heterogeneity. Leave-one-out meta-analysis was performed to evaluate the effect of each study on the overall estimate. Results: A total of 15 (N= 534387) studies were included between 2008-2021 in our Systematic review/Meta-analysis (Median follow-up duration: 29 days; mean age: 59-72 years; Males: 68.4%). 8 US-based studies, with the rest from Europe and South Asia, were included. A total of 34654 PCAF events were recorded. Pooled analysis of unadjusted (OR 1.23, 95%CI 1.07-1.42, p&lt;0.01) and adjusted (1.24, 95%CI 1.10- 1.40, p&lt;0.01) odds of PCAF was higher in OSA vs non-OSA cohorts. Subgroup analysis indicated greater risks of PCAF in prospective studies (OR 1.83, 95% CI 1.24-2.71 p 0.01) but not in retrospective studies. Rates of PCAF were higher in studies reported from other countries compared to the US (1.24 vs 1.18, p&lt;0.001) and with longer follow-up (&gt;3 years) compared to those with shorter follow-up (1 month) duration. Conclusions: In this meta-analysis, OSA predicted a nearly 25% higher risk of developing PCAF. Prospective studies assessing the long-term impact of OSA on cardiovascular risk after CABG are warranted to curtail worse outcomes.

The effects of high-sensitivity C-reactive protein on the clinical outcomes in obstructive sleep apnea patients undergoing off-pump coronary artery bypass grafting

PurposeTo investigate the relationship between obstructive sleep apnea (OSA) severity and high-sensitivity C-reactive protein (Hs-CRP), and their respective impact on the clinical outcomes in patients undergoing off-pump cardiac artery bypass grafting (OPCABG).MethodsWe enrolled consecutive eligible patients listed for elective OPCABG who underwent cardiorespiratory polygraphy before surgery between January 2019 and December 2019 in this prospective observational single-center study. Baseline, intraoperative, and postoperative clinical data were compared between absent-mild and moderate-severe OSA groups. Regression analysis investigated the relationship between Hs-CRP level and severity of OSA, and further assessed the factors influencing postoperative atrial fibrillation, duration of hospitalization, and hospital cost.ResultsPatients with moderate-severe OSA accounted for 42.3% (52/123) of the cohort. Partial pressure of carbon dioxide (PCO2), Hs-CRP, apnea hypopnea index (AHI), mean apnea time, maximum apnea time, and oxygen desaturation index ODI ≥ 3% were significantly higher in the moderate-severe OSA group than in the absent-mild OSA group. Left ventricle ejection fraction (LVEF), lowest arterial oxygen saturation (SaO2), and mean SaO2 were significantly lower in the moderate-severe OSA group. Moderate-severe OSA was associated with elevated Hs-CRP level (OR = 2.356, 95% CI 1.101–5.041, P = 0.027). Hs-CRP was an independent risk factor for post-CABG atrial fibrillation (POAF) (OR = 1.212, P = 0.01). Hs-CRP level independently correlated with duration of hospitalization (B = 0.456, P = 0.001) and hospital cost (B = 1.111, P = 0.044).ConclusionHs-CRP level was closely related to OSA severity and have potential utility in predicting POAF, duration of hospitalization, and hospital costs in patients undergoing OPCABG.

Proarrhythmic atrial structural and molecular remodeling with advancing age. Implications for post-coronary artery bypass grafting atrial fibrillation occurrence

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): This work was supported by a grant of the Romanian Ministry of Education and Research, CNCS-UEFISCDI Background Advancing age has been identified as a strong predictor of post-coronary artery bypass grafting (CABG) atrial fibrillation (AF). However, the exact substrate underlying this increased aging-related propensity to post-CABG AF remains insufficiently understood. Purpose We aimed to assess whether a preexisting electrical, structural, autonomic, and/or molecular remodeling could explain the increased risk of elderly individuals for post-CABG AF occurrence. Methods Thirty-one consecutive patients free of AF history scheduled for an elective CABG procedure were prospectively evaluated. All patients underwent continuous ECG monitoring prior to and following the CABG procedure, up to the day of discharge. The occurrence of post-CABG AF was recorded. The right atrial appendage, normally considered "surgical waste", was collected and divided into 3 samples that were used for single cell action potential recordings using the microelectrode technique, for histological, and mRNA analysis. Electrical remodeling preexistent to CABG was assessed by P-wave analysis (i.e., amplitude, duration, fragmentation) using 12-lead surface ECG and Lewis leads recordings and atrial action potential analysis (i.e., amplitude, duration). Atrial structural remodeling was evaluated using echocardiographic (i.e., left atrial [LA] area and antero-posterior diameter) and histological (i.e., fibrosis and fat tissue infiltration) parameters. Autonomic remodeling was evaluated using heart rate variability analysis based on the pre-CABG Holter ECG recordings. Molecular remodeling was assessed by mRNA analysis of several genes previously incriminated in AF occurrence (i.e., CACNA1C, GJA5, KCNE2, KCNJ2, KCNQ1, and SCN5A). Results Post-CABG AF occurred in 11 (35.4%) patients. Patients with post-CABG AF were significantly older than their non-arrhythmic counterparts (65.2 ± 5.8 years vs. 58.0 ± 10.4 years; p = 0.04). Age above 59 years predicted post-CABG AF with 81.8% sensitivity and 57.9% specificity. All analyzed electrical and autonomic parameters were similar between patients above and below the age of 59 years (all p &amp;gt;0.05). However, patients &amp;gt;59 years had significantly higher LA area and diameter (both p&amp;lt; 0.01), more important atrial fatty infiltration (p = 0.02), and significantly lower mRNA expression of SCN5A (p = 0.01). Conclusion In the present cohort, post-CABG AF occurrence was 3.4-fold more common in patients &amp;gt;59 years than in their younger peers. Although there was no evidence of aging-related cellular electrical or autonomic remodeling, elderly individuals presented significantly more important LA dilation and atrial fatty infiltration, and significantly lower expression of SCN5A, encoding for Na+ channels. These changes could contribute to the increased aging-related propensity to post-CABG AF by altering intra-atrial conduction and promoting reentry.

Lower Survival After Coronary Artery Bypass in Patients Who Had Atrial Fibrillation Missed by Widely Used Definitions.

ObjectiveTo investigate the impact of limiting the definition of post-coronary artery bypass graft (CABG) atrial fibrillation (AF) to AF/flutter requiring treatment—as in the Society of Thoracic Surgeons' (STS) database— on the association with survival.Patients and MethodsWe assessed in-hospital incidence of post-CABG AF in 7110 consecutive isolated patients with CABG without preoperative AF at 4 hospitals (January 1, 2004 to December 31, 2010). Patients with ≥1 episode of post-CABG AF detected via continuous in-hospital electrocardiogram (ECG)/telemetry monitoring documented by physicians were assigned to the following: Group 1, identified as having post-CABG AF in STS data and Group 2, not identified as having post-CABG AF in STS data. Patients without documented post-CABG AF constituted Group 3. Survival was compared via a Cox model, adjusted for STS risk of mortality and accounting for site differences.ResultsOver 7 years’ follow-up, 16.0% (295 of 1841) of Group 1, 18.7% (79 of 422) of Group 2, and 7.9% (382 of 4847) of Group 3 died. Group 2 had a significantly greater adjusted risk of death than both Group 1 (hazard ratio [HR]: 1.16; 95% confidence interval [CI], 1.02 to 1.33) and Group 3 (HR: 1.94; 95% CI, 1.69 to 2.22).ConclusionsThe statistically significant 16% higher risk of death for patients with AF post-CABG missed vs captured in STS data suggests treatment and postdischarge management should be investigated for differences. The historical misclassification of “missed” patients as experiencing no AF in the STS data weakens the ability to observe differences in risk between patients with and without post-CABG AF. Therefore, STS data should not be used for research examining post-CABG AF.

Left Atrial Size; a Missing Component in Scoring Systems for Predicting Atrial Fibrillation Following Coronary Artery Bypass Surgery.

Several risk factors have been associated with the development of postoperative atrial fibrillation (AF). However, some important factors that may play substantial roles have been neglected in the final suggested risk models. In this study, we aimed to derive a new clinical risk index to predict AF in coronary artery bypass graft (CABG) patients. In this retrospective cohort study we enrolled 3047 isolated CABG patients. A random sample of 2032 patients was used to derive a risk index for the prediction of post-CABG AF. A multivariate logistic regression model identified the independent preoperative predictors of post-CABG AF, and a simple risk index to predict AF was constructed. This risk index was cross-validated in a validation set of 1015 patients with isolated CABG. Post-CABG AF occurred in 15.9% and 15.7% of the patients in the prediction and validation sets, respectively. Using multivariate stepwise analysis, four preoperative variables including advanced age, left atrial (LA) enlargement, hypertension and cerebrovascular accident contributed to the prediction model (area under the receiver operating characteristic curve curve = 0.66). The effect of advanced age appeared to be dominant [age ≥ 75 years; odds ratio: 4.134, 95% confidence interval (CI): 2.791-6.121, p < 0.001]. Moderate to severe LA enlargement had an odds ratio of 2.176 (95% CI: 1.240-3.820, p = 0.013) for developing AF in our risk index. LA size was an important factor in risk stratification of post-CABG AF, which remained significant in the final model. Future scoring system studies might benefit from the use of this variable to obtain a more robust predictive value.

The predictive value of the combined systolic-diastolic index for atrial fibrillation after coronary artery bypass surgery.

Atrial fibrillation (AF) after coronary artery bypass grafting (CABG) is a factor that causes an increase in mortality and morbidity. Therefore, predicting post-CABG AF development is important for treatment management. In this study, we investigated the value of the ratio E/(Ea×Sa) as a combined systolic-diastolic index in predicting post-CABG AF development. This prospective study included 102 patients who underwent only isolated coronary bypass. Preoperative demographic features, biochemical, and hematological parameters, and the electrocardiographic data of all patients were recorded. The E/(Ea×Sa) indices were calculated from the echocardiographic measurements. Those who retained their postoperative sinus rhythm were defined as group 1, and those who developed AF were defined as group 2. Group 2 had significantly higher lateral (group 1:1.14±0.61 vs. group 2:1.47±0.87; P=.02), medial (group 1:1.61±0.70 vs. group 2:1.99±0.91; P=.02), and mean (group 1:1.30±0.58 vs. group 2:1.62±0.74; P=.001) E/(Ea×Sa) indices than group 1. In the univariate analysis, age, CHA2 DS2 -VASc score, sPAP, IABP use, and mean E/(EaxSa) index were found to be significant predictors of post-CABG AF development. However, only the mean E/(EaxSa) index was found to be a significant predictor of post-CABG AF development in the multivariate analysis (OR: 2.19 95% CI 1.01-5.96; P=.045). The combined systolic-diastolic index predicted the development of post-CABG AF.

Anticoagulation and amiodarone for new atrial fibrillation after coronary artery bypass grafting: Prescription patterns and 30-day outcomes in the United States and Canada

ObjectiveWe sought to elucidate national practice patterns regarding anticoagulation and antiarrhythmic medication use at discharge and examine short-term patient outcomes. MethodsIn this retrospective cohort study, we analyzed the data of patients from the Society of Thoracic Surgeons Adult Cardiac Surgery Database from July 2011 to June 2018 who underwent first-time isolated coronary artery bypass graft surgery (CABG) and developed new post-CABG atrial fibrillation (AF) without significant complications. In total, 166,747 patients met study criteria. We examined 30-day outcomes. ResultsIn total, 166,747 patients were analyzed and divided into 4 groups based on discharge medications: amiodarone with or without anticoagulation, anticoagulation alone, and neither. Demographic characteristics were similar among the 4 groups. In total, 25.7% of patients were discharged on anticoagulation with an average CHA2DS2-VASc score of 3.2 ± 1.3. Anticoagulation use at discharge was not associated with lower 30-day stroke readmissions (adjusted odds ratio [AOR], 0.87; 95% confidence interval [CI], 0.65-1.16; P = .35). Adjusted 30-day readmissions for major bleeding were significantly more common in anticoagulated patients (AOR, 4.30; 95% CI, 3.69-5.03; P < .0001). Among those discharged off anticoagulation, there was no significant difference in adjusted 30-day stroke rates based on amiodarone use at discharge (AOR, 1.19; 95% CI, 0.85-1.66; P = .31). ConclusionsPost-CABG anticoagulation for new AF is associated with increased bleeding and no difference in stroke at 30 days. Prospective randomized studies are needed to formalize safe and efficacious short- and long-term management strategies.

COMPARATIVE EFFECTIVENESS OF RADIOFREQUENCY PULMONARY VEIN ISOLATION PLUS AMIODARONE THERAPY IN PREVENTING POST-CORONARY ARTERY BYPASS GRAFTING ATRIAL FIBRILLATION

Objective. To evaluate the effectiveness of epicardial bipolar radiofrequency ablation (RFA) of pulmonary vein ostia (PV) in comparison with its being combined with amiodarone administration for post-CABG atrial fibrillation (AF) prevention.Methods. A single-centre, prospective randomized study (PULVAB), including 96 CAD patients with no history of AF, was conducted between January 2015 and December 2018. Group 1 (control; n=34) had standard CABG alone. Group 2 (n=29) received RFA of PV as an adjunct to CABG for prevention of postoperative AF (POAF). Group 3 patients (n=33) had RFA at the time of CABG and were given amiodarone. Allocation was concealed using sequentiallynumbered opaque envelopes. The efficacy and safety of RFA concomitant with CABG were assessed, as both performed independently and combined with amiodarone administration, as well as intra-and postoperative course.Results. No differences were seen in operation length (p=0.937), cardiopulmonary bypass (CPB) or the aorta clamping times (р=0.377 and p=0.072, respectively). The study groups (CABG, CABG-RFA, CABG-RFA-amiodarone) did not differ statistically in the number of shunts placed - 3.17±0.61, 3.10±0.51 and 2.94±0,6 (p=0,121). No significant difference was noted in RFA duration between Groups 2 and 3 - 11.7±3.7 and 11.4±6.3 min, respectively (p=0,834).AF was found to occur most commonly at postoperative days two or four. The isolated CABG surgery group patients developed POAF most often of all (32,4%). The incidence of POAF was lower after RFA concomitant to CABG - 20.7% (р=0,29). A significant difference was identified in POAF incidence between Groups 1 and 3- 32.4% and 6.1%, respectively (p = 0.0065). Differences between Groups 2 and 3 proved not to be statistically significant (р= 0,086). Sinus rhythm in most of those who had developed arrhythmias was restored by pharmacological cardioversion except for three patients (one in each group). At discharge, 97.1% , 96.7% and 97% of the subjects in Groups 1, 2 and 3, respectively, exhibited sinus rhythm (p&gt;0,05).There was no in-hospital mortality in any of the groups. Neither were there any wound complications, reoperations, perioperative myocardial infarction or cerebral circulatory disorders observed. No difference was revealed in the severity and frequency of renal or respiratory failure. The mechanical lung ventilation time and duration of stay in the ICU in the isolated CABG group were shown to be increased as compared with the CABG-RFA and CABG-RFA-amiodarone groups (p&lt;0.05).Conclusion. The evidence from the pilot study (PULVAB) suggests that bipolar ablation of PV does not significantly complicate CABG, while being combined with amiodarone administration for prevention of rhythm disorders it significantly reduces the incidence of POAF. The in-hospital incidence of POAF tended to decrease, which was not statistically significant, though. Evaluating the efficacy of RFA concomitant with CABG, as performed independently, invites further investigation with more data analysis.

Postcoronary Artery Bypass Graft Atrial Fibrillation Event Count and Survival: Differences by Sex

New-onset atrial fibrillation (AF) after coronary artery bypass graft surgery (CABG) is associated with poor outcomes, but data on the effects of its characteristics are lacking and conflicting. We examined the effect number of post-CABG AF events has on long-term mortality risk, and whether this is sex dependent. Routinely collected Society of Thoracic Surgeons (STS) data were supplemented with details on new-onset post-CABG AF (detected in-hospital by continuous electrocardiogram/telemetry monitoring) and long-term survival for 9203 consecutive patients with isolated-CABG (2002-2010). With the use of Cox regression, we determined the propensity-adjusted (STS-recognized risk factors) effect of number of AF events on survival, testing for effect modification by sex and controlling for AF duration. AF occurred in 739 women (29.4%) and 2157 men (32.3%) (P < .001). Adjusted results showed 2 or more AF events significantly (P < .001) increased 5-year mortality risk, independently of total AF duration. However, mortality risk differed between the sexes (P<.001): women with 2 AF episodes had the greatest increase (hazard ratio [HR]= 2.98; 95% confidence interval [CI], 1.43-4.83; versus women without AF), followed by women and men with 4 or more AF events (HR= 2.76 [95% CI, 1.27-4.55] and HR= 2.73 [95% CI,2.30-3.19], respectively). A single post-CABG AF episode was not associated with increased mortality risk. Both men and women who experienced 2 or more post-CABG AF episodes showed increased risk of 5-year mortality, independent of total AF duration. Although men's risk increased as the number of AF events increased, women's risk peaked at 2 AF events. Future research needs to determine whether this divergence stems from differences in treatment/management or underlying biology.

Postoperative atrial fibrillation: Sex-specific characteristics and effect on survival

BackgroundWe sought to fill important gaps in the existing evidence regarding new-onset atrial fibrillation (AF) after coronary artery bypass graft surgery (CABG) by comparing the incidence, characteristics, and effect on long-term survival between men and women. MethodsNine thousand two hundred three consecutive patients without preoperative AF underwent isolated CABG from 2002 to 2010 at 3 US academic medical centers and 1 high-volume specialty cardiac hospital. Detailed data on CABG AF events detected via continuous in-hospital electrocardiogram/telemetry monitoring were supplemented with Society of Thoracic Surgeons data, and survival data, censored at October 31, 2011, using a copy of the Social Security Death Master File archived before state-owned data were removed (November 1, 2011). ResultsPropensity-adjusted (Society of Thoracic Surgeons-recognized risk factors) incidence of post-CABG AF was 31.5% overall, 32.8% in men, and 27.4% in women. Over the 9-year study period, women had a significantly lower risk of post-CABG AF (absolute difference, −5.3% [95% confidence interval (CI), −10.5% to −0.6%]), and significantly shorter first (−2.9 hours; 95% CI, −5.8 to 0.0), and longest (−4.3 hours; 95% CI, −8.3 to −0.3) AF duration. Post-CABG AF was associated with significantly increased risk of long-term mortality (overall hazard ratio [HR], 1.56; 95% CI, 1.45-1.67; men HR, 1.57; 95% CI, 1.49-1.65; women HR, 1.54; 95% CI, 1.14-2.07). ConclusionsIn our study, women had lower adjusted risk of post-CABG AF and experienced shorter episodes. The adjusted risk of long-term mortality was 56% greater among patients who developed post-CABG AF compared with those who did not. The effect of post-CABG AF on long-term survival did not differ between the sexes.

Does vitamin C, as an adjunct to betablocker therapy, decrease the incidence of post-CABG atrial fibrillation?

Does vitamin C, as an adjunct to betablocker therapy, decrease the incidence of post-CABG atrial fibrillation?

Cardio-autonomic functions and sleep indices before and after coronary artery bypass surgery.

BACKGROUND:Earlier studies showed a short-term impairment of cardio-autonomic functions following coronary artery bypass grafting (CABG). There is a lack of consistency in the time of recovery from this impairment. Studies have attributed the post-CABG atrial fibrillation to preexisting obstructive sleep apnea (OSA) without an objective sleep assessment. The aim of this study was to evaluate the effect of CABG on cardio-autonomic and hemodynamic functions and on OSA indices in patients with ischemic heart disease (IHD).METHODS:Cardio-autonomic function using heart rate variability indices, hemodynamic parameters, and sleep studies were performed in 26 patients with stable IHD before, on day-6, and day-30 post-CABG surgery.RESULTS:The high-frequency powers of normalized R-R intervals significantly (P = 0.002) increased from the preoperative value of 46.09 to 66.52 on day-6 and remained unchanged on day-30 postsurgery. In contrary, the low-frequency powers of normalized R-R interval decreased from 53.91 to 33.48 during the same period (P = 0.002) and remained unchanged on day 30 postsurgery. Baroreceptor sensitivity, obstructive and central apnea indices, desaturation index, and lowest O2 saturation were not significantly different between preoperative, day-6, and day-30 postsurgery.CONCLUSION:Our study revealed that recovery of autonomic functions following CABG occurs as early as 30 days of postsurgery. CABG does not seem to have short-term effects on sleep study indices. However, long-term effects need further evaluation.

Incidence of atrial fibrillation after off-pump versus on-pump coronary artery bypass grafting: A meta-analysis of randomized clinical trials and propensity score matching trials.

The association between atrial fibrillation (AF) after coronary artery bypass grafting (CABG) and the surgical techniques selected has been extensively reported. However, no consistent results were obtained. In the present study, a meta-analysis was conducted by searching the electronic databases PubMed, Embase, Web of Science, and Cochrane to identify the association of post-CABG AF with on-pump (conventional CABG, cCABG) or off-pump CABG (OPCABG). Outcomes from randomized clinical trials (RCTs) and propensity score matching (PSM) trials were pooled by using the fixed-effect or the random-effect modeling method, and verified by the quality-effect modeling method. There were 35 studies with 36 independent reports that met the inclusion criteria and were eventually included in our meta-analysis. The total odds ratio (OR) of the incidence of post-CABG AF between OPCABG and cCABG was 0.80 (95% CI 0.71-0.91). The 25 randomized clinical trials (RCTs) had an OR of 0.69 (95% CI 0.56-0.86), while the OR of the 11 PSM trials was 0.88 (95% CI 0.77-1.00). Twenty-six studies involving the patients at a mean age no more than 65 years showed an OR of 0.76 (95% CI 0.64-0.90), whereas 10 studies with patients greater than 65 years old showed an OR of 0.90 (95% CI 0.78-1.05). The results of this meta-analysis suggest that OPCAB surgery may reduce the incidence of post-CABG AF when compared to cCABG and that younger patients may benefit more from OPCAB and have a lower incidence of post-CABG AF.

Predicting New-Onset Post-Coronary Artery Bypass Graft Atrial Fibrillation With Existing Risk Scores

New-onset atrial fibrillation (AF) after coronary artery bypass graft (CABG) operation is associated with poorer survival. Blanket prophylaxis efforts have not appreciably decreased incidence, making targeted prevention for high-risk patients desirable. We compared predictive abilities of existing scores developed/used to predict adverse CABG outcomes (Society of Thoracic Surgeons' [STS] risk of mortality) or AF not associated with cardiac operation (the Cohorts for Heart and Aging Research in Genomic Epidemiology [CHARGE]-AF score, the CHA2DS2-VASc score), and a risk model for predicting postoperative AF following cardiac operations (POAF score), with age (the most consistently identified post-CABG AF risk factor). Data submitted to the STS Adult Cardiac Surgery Database were used to assess new-onset AF in 8,976 consecutive patients without preoperative AF undergoing isolated CABG from 2004 to 2010 at five participating centers. Five logistic regression models (for CHA2DS2-VASc score, CHARGE-AF score, POAF score, STS risk score, and age, respectively, all modeled with restricted cubic splines) with a random effect for site were fitted to predict post-CABG AF. Estimates were used to compute and compare receiver operating characteristic (ROC) areas. New-onset AF occurred in 2,141 patients (23.9%). The ROC area was greatest for CHARGE-AF (0.68, 95% confidence interval [CI]: 0.67-0.69), followed by age (0.66, 95% CI: 0.65-0.68), POAF score (0.65, 95% CI: 0.64-0.66), CHA2DS2-VASc (0.59, 95% CI: 0.58 to 0.60), and STS risk of mortality (0.58, 95% CI: 0.56-0.59). CHARGE-AF was significantly more predictive than age (p < 0.0001); the other scores were significantly less predictive (p < 0.0001). Only CHARGE-AF performed better than age alone. Its performance was moderate and comparable with published risk models specifically targeted at new-onset post-isolated CABG AF. Future research should continue to focus on developing better predictive models.

A prospective study of preoperative echocardiographic predictors of post CABG atrial fibrillation

A prospective study of preoperative echocardiographic predictors of post CABG atrial fibrillation

Evaluation of amiodarone versus metoprolol in treating atrial fibrillation after coronary artery bypass grafting.

IntroductionAtrial fibrillation (AF) is the most common arrhythmia affecting patients in open heart ICU after coronary artery bypass grafting (CABG). Most cardiac surgery textbooks recommend beta blockers as the drug of choice for treating such a condition while many experienced physicians and a number of anesthesiology references offer amiodarone as the drug of choice. Therefore, because of insufficient evidence and the aforementioned controversy, we decided to conduct a study evaluating these two antiarrhythmic medicines.MethodsThis is a double-blind, randomized, clinical trial performed on patients admitted for CABG at Amir al Momenin hospital in Arak province, Iran, who developed new onset AF after surgery. Based on the type of medication used, these patients were randomly divided into two groups: amiodarone (A) group and metoprolol (M) group. Each group consisted of 73 cases. All data were analyzed via SPSS 19. Results Among the results achieved in this study, amiodarone was successful in treating AF in 55 patients (73%), while metoprolol achieved normal rhythm in treating AF in 69 patients (92%). With a p-value of 0.04, it seems that metoprolol is more effective in treating AF.ConclusionMetoprolol seems to be a most efficacious medication for post-CABG AF (p-value = 0.004).