Postoperative Atrial Fibrillation In Cardiac Surgery Research Articles

Scoring system for predicting the Post-Operative Atrial Fibrillation (POAF) in post-cardiac surgery: a literature review

Link of Video Abstract: https://youtu.be/tl9Q8g6DUdcBackground: Coronary artery bypass grafting (CABG) is still one of the optimal treatment options for revascularization in coronary heart disease. Despite Atrial Fibrillation being the most common arrhythmia after CABG, there’s still no agreement on which risk assessment to predict the incidence of Post Operative Atrial Fibrillation (POAF). Some studies have shown that the findings of Atrial fibrillation after CABG are associated with increased hemodynamic disturbances, thromboembolic manifestations, readmission to the Intensive Care Unit (ICU), increased length of stay, organ failure, and death. This study aims to analyze the scoring system used for predicting the incidence of POAF in cardiac surgery. Methods: This study used “POAF” AND “Scoring system," AND "CABG” AND “Atrial Fibrillation” as keywords to explore the literature from PubMed, Google Scholar, ProQuest, and Clinical Key. Search engines were searched for relevant papers from the last 15 years. Result: CHA2DS2-VASc score has a sensitivity of 74.2%, a specificity of 44.7% and can identify patients who are predicted to have a high risk of experiencing POAF by 49.4%. The CHA2DS2-VASc score can be used as an independent predictor for predicting POAF. HATCH score cut-off point exceeding 1 was linked to AF prediction, yielding a sensitivity of 42% and specificity of 70%. POAF Score, the scoring system anticipates an increased likelihood of POAF development (58.5%). A score of 1 corresponds to a 30.1% probability of POAF occurrence and is a practical point for commencing preventive therapy. Conclusion: Despite the various scoring systems used to predict postoperative atrial fibrillation, including the CHA2DS2-VASc score, HATCH score and Mariscalco. POAF Score demonstrated a validated ability to predict POAF.

Factors affecting the occurrence of postoperative atrial fibrillation in cardiac surgery patients

Abstract Funding Acknowledgements Type of funding sources: None. Intorduction. Postoperative atrial fibrillation (POAF) is the most common arrhythmia after cardiac surgery and is a serious clinical problem. POAF refers to new-onset atrial fibrillation developing immediately after surgery. Despite advances in surgical and perioperative techniques, it remains the most common adverse event in cardiac surgery. Many studies are being conducted to obtain detailed information on the mechanisms underlying POAF, its course and effective treatment methods. Despite a significant improvement in treatment outcomes after cardiac surgery, the incidence of POAF did not change. It continues to be a major burden for patients, physicians and healthcare systems increasing hospitalization and healthcare costs as reflected in longer hospital stays, increased post-operative complications and increased mortality. Purpose Identification of factors determining the occurrence of POAF in patients after cardiac surgery. Material and Methods 125 patients (53 women, 72 men, mean age 68.68 ± 7.11) qualified for elective cardiac surgery were included in the study. Patients with persistent or paroxysmal atrial fibrillation diagnosed before the procedure were excluded from the study. The study took into account a number of sociodemographic and clinical data, which were collected on the basis of patients' medical records from the course of hospitalization (sex, age, weight, height, BMI, place of residence, type of surgery, duration of surgery, perioperative risk according to EuroScore II, results of laboratory tests before and after surgery, the presence of comorbidities and multi-morbidity, hospitalization time). In addition, the score obtained in the CHA2DS2–VASc scale was taken into account in the analysis. The assumed significance level was p < 0.05. Results POAF was identified in 41% of patients. The average perioperative risk in the study group was M± SD = 2.05 ± 1.61. It was noted that POAF is significantly more common in women than in men (21.6% vs. 19.2%; p = 0.048). Patients with POAF had a significantly higher BMI than patients without POAF (29.20±3.81 vs. 27.89±4.14, p = 0.38). In patients with POAF, a statistically significant correlation was found between the loss of platelets during the procedure and the length of hospitalization (r = -0.387, p<0.005). In the study group, there was no relationship between the occurrence of POAF and the type of surgery, duration of surgery, loss of hemoglobin, total protein, decrease in potassium levels, the presence of comorbidities, multimorbidity, CHA2DS-VAc score). Conclusions 1. Female sex is an unmodifiable factor determining the occurrence of POAF in cardiac surgery. 2. Overweight is a modifiable factor determining the occurrence of POAF in cardiac surgery. 3. Perioperative platelet loss in patients with POAF results in longer hospital stay after cardiac surgery.

Prediction of postoperative atrial fibrillation with postoperative epicardial electrograms

Objectives. New-onset postoperative atrial fibrillation (POAF) is a common complication after cardiac surgery. The arrhythmia often entails a longer hospital stay, greater risk of other complications, and higher mortality both short- and long-term. An investigation of the use of early atrial electrograms in predicting POAF in cardiac surgery was performed. Design. In this prospective observational study, a total of 99 consecutive adult patients undergoing coronary artery bypass grafting, valve surgery or both were included. On the first postoperative morning, standard 12-lead electrograms (ECG), unipolar atrial electrograms (aEG), and vital values were recorded. The outcome was new-onset POAF within one month postoperatively. Results. Three multivariable prediction models for POAF were formed using measurements derived from the ECG, aEG, and patient characteristics. Age, body mass index, and two unipolar electrogram measurements quantifying local activation time and fractionation were strongly associated with the outcome POAF. The performance of the POAF prediction models was assessed through receiver operating curve characteristics with cross-validation, and discrimination using the leave-one-out-method to internally validate the models. The cross-validated area under the receiver operating characteristic curve (AUC) was improved in a prediction model using atrial-derived electrogram variables (AUC 0.796, 95% CI 0.698–0.894), compared with previous ECG and clinical models (AUC 0.716, 95% CI 0.606–0.826 and AUC 0.718, 95% CI 0.613–0.822, respectively). Conclusions. This study found that easily obtainable measurements from atrial electrograms may be helpful in identifying patients at risk of POAF in cardiac surgery.

Preemptive Pharmacogenetic-guided Metoprolol Management for PostoperativeAtrial Fibrillation in Cardiac Surgery

Preemptive Pharmacogenetic-guided Metoprolol Management for PostoperativeAtrial Fibrillation in Cardiac Surgery

Storage time of intraoperative transfused allogeneic red blood cells is not associated with new-onset postoperative atrial fibrillation in cardiac surgery.

BackgroundAllogeneic red blood cell (RBC) transfusion has been associated with new-onset postoperative atrial fibrillation (POAF) following cardiac surgery. Prolonged storage time of RBC may increase the risk. The primary aim of the study was to evaluate whether the storage time of RBC is associated with development of POAF.Materials and methodsPre-, per- and postoperative data were retrieved from the Western Denmark Heart Registry and local blood banks regarding patients who underwent coronary artery bypass surgery, valve surgery or combined procedures in Aalborg or Aarhus University Hospital during 2010–2014. Multiple logistic regression was used to determine the risk of POAF according to transfusion of RBC on the day of surgery. Furthermore, we determined trend in storage time of RBC according to risk of POAF using restricted cubic splines. Patients with a history of preoperative atrial fibrillation, patients who received transfusions preoperative and patients who died at the day of surgery were among excluded patients.ResultsA total of 2,978 patients with a mean age of 66.4 years were included and 609 patients (21%) received RBC transfusion on the day of surgery. POAF developed in 752 patients (25%) and transfused patients were at an increased risk compared with non-transfused patients (adjusted Odds Ratios for patients receiving RBC: 1.37; 95% CI: 1.11–1.69, P-value = 0.004). However, RBC transfusion was not necessarily the cause of POAF and may only be a marker for development of POAF. There was no significant association between storage time of RBC and POAF.ConclusionsIn contrast to intraoperative allogeneic RBC transfusion in general, increased storage time of RBC is not associated with development of POAF in cardiac surgery.

Abstract 13387: Effect of Ranolazine on the Incidence of Atrial Fibrillation Following Cardiac Surgery

Introduction: Atrial fibrillation (AF) is common following cardiac surgery. Reduction of postoperative AF would decrease average length of stay and improve patient outcomes. Ranolazine has been shown to prevent AF by increasing postrepolarization refractoriness in atrial tissue. This study evaluates prophylactic ranolazine on postoperative AF in cardiac surgery. Hypothesis: To assess the effect of ranolazine as a selective atrial sodium channel blocker on prevention of AF following cardiac surgery. Methods: This double blinded, randomized trial assessed primary prevention of postoperative AF with ranolazine in patients undergoing coronary artery bypass grafting (CABG) and/or aortic valve replacement (AVR) from 2012-13. Mitral valve surgery was an exclusion criterion. Fifty-four patients were randomly allocated to twice daily ranolazine 1000 mg (n=27) or placebo (n=27) 48 hours prior to surgical intervention and postoperatively for 14 days. Cardiac monitoring for arrhythmias was continued for 2 weeks post discharge using Holter monitor. The primary endpoint was AF up to postoperative day 14. Secondary endpoints included 30 day readmission, complications, and length of stay. (ClinicalTrials.gov: NCT01590979). Results: Fifty-one patients completed the study to 30 days postoperatively. Cohort mean age was 64.3±11.4 years, females were 10(19%), mean ejection fraction was 46.4±14.6%, hypertension 48(89%), dyslipidemia 32(59%) and diabetes 22 (41%), with no difference between the groups. Patients underwent isolated CABG (44, 81%), AVR (4, 7%) and combined AVR/CABG (3, 6%). The incidence of AF was 24%, control 8 (30%) and treated 5 (19%) groups, a 38% reduction, not statistically significant (p=0.530). QT duration was longer in the ranolazine group (p=0.014). The length of stay of patients who developed AF was significantly longer (8.3±5.0 vs. 5.4±2.7, p=0.009), with no drug related adverse events. Conclusion: This study illustrates the prevalence of AF following cardiac surgery. Ranolazine is an antianginal medication that can be used safely in patients to reduce postoperative AF. In conclusion, this study showed a reduction in the incidence of AF by 38%. Although not statistically significant, this indicates a trend towards our hypothesis.