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Predictors of atrial fibrillation after off-pump coronary artery bypass graft surgery

Alberto Zangrillo, Giovanni Landoni, Donatella Sparicio, Stefano Benussi, Giacomo Aletti, Federico Pappalardo, Giulia Fracasso, Greta Fano, Giuseppe Crescenzi
Journal of Cardiothoracic and Vascular Anesthesia 2004, 18 (6): 704-8
15650977

OBJECTIVE: Atrial fibrillation is the most common complication after coronary artery bypass graft surgery. This arrhythmia may lead to hemodynamic compromise, prolonged hospitalization, and increased risk for cerebral thromboembolism. Older age is the only variable consistently associated with the development of postoperative atrial fibrillation; however, no strong predictive model exists. The purpose of this study was to identify perioperative characteristics associated with new-onset atrial fibrillation in patients undergoing off-pump coronary artery bypass grafting.

DESIGN: Prospective, observational.

SETTING: University tertiary care hospital.

PARTICIPANTS: One hundred sixty consecutive patients undergoing off-pump coronary artery bypass grafting.

INTERVENTIONS: None.

MEASUREMENTS AND MAIN RESULTS: Incidence of postoperative atrial fibrillation was the major outcome. Atrial fibrillation occurred in 33 patients (20.6%). Multivariate analysis identified reintervention (odds ratio 26.8), revascularization of the ramus medianus (odds ratio 3.9), and age (odds ratio 1.069 per year) as the only independent predictors of postoperative atrial fibrillation. All patients were in sinus rhythm at hospital discharge. One hospital death was noted.

CONCLUSIONS: Despite the less invasive approach, the incidence of postoperative atrial fibrillation is high after off-pump coronary artery bypass grafting. Older age, grafting of the ramus medianus, and a redo operation were predictors of new-onset postoperative atrial fibrillation. It is possible that left atrial stretching with heart dislocation during revascularization of the lateral wall could lead to postoperative atrial fibrillation.

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