Predictors of new-onset atrial fibrillation in elderly patients with coronary artery disease after coronary artery bypass graft

Objective To identify the factors associated with the development of postoperative atrial fibrillation (POAF) after coronary artery bypass graft (CABG) in elderly patients with coronary artery disease (CAD). Methods A total of 81 patients with CAD who underwent CABG were enrolled in the study. Patients were divided into two groups: Group 1, without postoperative atrial fibrillation (59 patients, 74.6% men, mean age 65.8 ± 4.0 years); Group 2, with early new-onset atrial fibrillation after CABG (22 patients, 90.9% men, mean age 67.7 ± 5.4 years). Interleukin (IL)-6, IL-8, IL-10, C-reactive protein (CRP), fibrinogen, superoxide dismutase (SOD), N-terminal pro-B-type natriuretic peptide (NT-proBNP), and troponin I were studied. Results During the observation period, atrial fibrillation occurred in 27.2% cases, an average of 4.9 ± 3.8 days after surgery. In group 2, the left atrium (LA) dimension was larger than in group 1 (43.9 ± 3.4 mm vs. 37.6 ± 3.9 mm, P < 0.001). Patients with POAF had significantly higher IL-6 (72.7 ± 60.8 pg/mL vs. 38.0 ± 34.6 pg/mL, P = 0.04), IL-8 (11.9 ± 6.0 pg/mL vs. 7.7 ± 5.4 pg/mL, P = 0.01) and SOD (2462.0 ± 2029.3 units/g vs. 1515.0 ± 1292.9 units/g, P = 0.04) compared with group without POAF. The multivariate analysis showed that the odds ratio (OR) for POAF development in patients with left atrium more than 39 mm was 2.1 [95% confidence interval (CI): 1.2?3.8, P = 0.0004], IL-6 levels more than 65.18 pg/mL—1.4 (95% CI: 1.1?2.7, P = 0.009), IL-8 levels more than 9.67 pg/mL—1.2 (95% CI: 1.1?3.7, P = 0.009), SOD more than 2948 units/g—1.1 (95% CI: 1.01?2.9, P = 0.04). Conclusions In our study, the independent predictors of postoperative atrial fibrillation after CABG in elderly patients were left atrium dimension and the increased postoperative concentration of IL-6, IL-8 and superoxide dismutase.     

冠状动脉旁路移植术后心房颤动的相关危险因素研究

目的研究冠状动脉旁路移植术（CABG）后心房颤动（AF）的相关危险因素。方法回顾性分析我院427例冠状动脉旁路移植术患者的病例资料,并根据术后是否发生房颤分为AF组和非AF组。比较两组资料,进行统计分析,筛选高危因素。结果本组CABG术后心房颤动发生率为21．31％。单因素分析,年龄、吸烟史、高血压史、P波离散度、RCA近中段狭窄〉50％、左心房内径（LAD）、左室射血分数（LVEF）、采用体外循环与否、同期行瓣膜手术与否、移植血管数目差异均具有统计学意义。多因素logistic回归分析提示,年龄〉65岁、P波离散度〉40s、RCA近中段狭窄〉50％、LAD〉40mm、LVEF≤40％均与术后房颤发生有显著相关性。结论年龄〉65岁、P波离散度〉40s、RCA近中段狭窄〉50％、LAD〉40mm、LVEF≤40％是CABG术I暑皂鲕倍士的倍除隅壹     

Effectiveness of triple-site triggered atrial pacing for prevention of atrial fibrillation after coronary artery bypass graft surgery

BACKGROUND: Recently, several temporary multisite pacing methods have been developed for prevention of postoperative atrial fibrillation (AF). HYPOTHESIS: In this study, we evaluated the effect of triple-site temporary triggered pacing in the AAT mode on the development of AF in patients undergoing coronary artery bypass graft (CABG) at high risk for developing postoperative AF. METHODS: A total of 70 patients undergoing CABG were randomly assigned either to pacing group (study group, n = 35 patients) or to no pacing group (control group, n = 35 patients). The external pacemaker was programmed to pace at the atrial triggered mode at a lower rate of 40 beats/min for 4 days. RESULTS: Atrial fibrillation, defined as lasting > 30 s, occurred in 4 patients (11.4%) in the study group and in 16 patients (45.7%) in the control group (p = 0.003). Sustained AF, defined as AF lasting > 10 min, also was observed less frequently in the study group than in the control group (11.6 vs. 37.1%, p = 0.024). Triple-site triggered atrial pacing was observed to reduce the incidence of AF by 75% and the incidence of sustained AF by 69%. CONCLUSIONS: We believe that multiple-site temporary pacing in the triggered mode is an effective way of preventing postoperative AF. This technique may be used especially in patients at high risk of developing AF.     

冠状动脉旁路移植术后心房颤动临床研究

目的　调查冠状动脉旁路移植术后心房颤动 (房颤 )发生率和临床表现 ,并探讨其易患危险因素。　方法　连续收集 116例接受冠状动脉旁路移植手术的冠心病患者 ,男性 93例 ,女性 2 3例 ,术后监测心律状况、观察临床特点。详尽考查患者术前、术中、术后诸因素 (变量 )。采用单因素分析和逻辑多元回归分析 ,筛选术后房颤相关因素。　结果　 33例于冠状动脉旁路移植术后出现房颤 ,发生率2 8.4%。发生房颤者大多有明显症状 ,经静脉药物转复率较低 ,多元回归分析表明高龄、左心房扩大为冠状动脉旁路移植术后发生房颤的独立危险因素。　结论　房颤为冠状动脉旁路移植术后常见心律失常 ;增龄和左心房扩大为重要的独立危险因素     

冠状动脉搭桥术后早期新发房颤的临床研究进展

术后新发房颤（new-onset post-operative atrial fibrillation）是冠状动脉搭桥术后早期最常见的并发症之一,发病率为30％～50％,并随着患者年龄的增长而显著升高[1-7].术后新发房颤,特别是快速房颤,不仅会影响患者术后心功能,而且可使术后死亡率明显升高[1-3].近年来随着医学技术的不断发展,冠状动脉搭桥手术出现了如不停跳搭桥、微创小切口搭桥、机器人辅助搭桥等新的手术方式,不仅减轻了手术创伤,而且在一定程度上降低了术后并发症的发生率[8].     

冠状动脉旁路移植术后心房颤动的高危因素分析

目的　研究冠状动脉旁路移植术 (CABG)后心房颤动 (AF)的发病特点 ,分析AF的高危因素。方法　采用回顾性研究的方法 ,观察我院CABG患者 2 35例 ,监测手术前后心电图、2 4h动态心电图、心肌酶谱、心脏收缩功能、左心房内径、体外循环及主动脉阻断时间、和电解质变化等。结果　 2 35例患者CABG术后 4 2例 (17 9% )发生AF ,81%的AF发生于术后 1～ 3d ,持续 (12 0± 9 14 )h ,95 2 %患者 2 4h内恢复窦性心律 ;高龄 (≥ 70岁 )、低钾血症 (≤ 3 5mmol/L)、低镁血症 (≤ 0 70mmol/L)、左心功能不良[射血分数 (EF)≤ 0 4 0和 /或缩短分数 (FS)≤ 0 2 4 ]、左心房内径≥ 35mm、右冠状动脉狭窄≥ 70 %的患者术后AF发生率明显高于其他患者 (P分别为 0 0 0 1、0 0 0 9、0 0 16、0 0 30、0 0 36和 0 0 4 4 ) ;应用胺碘酮患者AF发生率明显降低。结论　低镁血症、左心房增大、右冠状动脉病变是术后AF的相关因素 ;高龄、左心室功能不良、低钾血症是术后AF的独立高危因素 ;预防应用胺碘酮能明显降低术后心室率 ,有效地抑制术后AF的发生 ,促进AF转复 ,明显改善左心室功能 ,并且具有较好安全性和耐受性 ,是术后AF的保护因素     

Heart rate turbulence for predicting new-onset atrial fibrillation in patients undergoing coronary artery bypass grafting

Background

Cardiac autonomic dysfunction reportedly contributes to the AF triggering and maintenance. Heart rate turbulence (HRT) is a promising noninvasive measure of cardiac autonomic function. We investigated whether ambulatory ECG-based HRT measurement could predict in-hospital new-onset atrial fibrillation (AF) after coronary artery bypass graft (CABG) surgery.

Methods

HRT onset (TO) and slope (TO) were prospectively measured from 24-h Holter recording in 113 consecutive patients prior to CABG. Abnormal HRT was defined as at least one abnormal value in TO (> 0%) and TS (< 2.5 ms/RR).

Results

Patients with abnormal HRT (n = 60) showed a significantly higher AF incidence (47% versus 21%, P = 0.005) and AF burden (29 ± 9 versus 7 ± 5 h, P = 0.043) than those with normal HRT (n = 53). Abnormal HRT were identified as independent predictors for the new-onset postoperative AF. During the follow-up period (12.0 ± 10.5 months), the abnormal HRT group showed a worse prognosis versus the normal HRT group regarding the AF recurrence/postoperative stroke (P = 0.018). Additionally, the postoperative AF incidence, in-hospital AF burden, and the rate of AF recurrence/postoperative stroke gradually elevated as the number of abnormal HRT values increased from 0 to 2.

Conclusions

Preoperative abnormal HRT was significantly associated with worse short-term (in-hospital new-onset AF) and long-term outcomes (post-discharge AF recurrence/postoperative stroke) after CABG surgery. Additional studies incorporating preventive interventions depending on the preoperative HRT results might be worthwhile in this patient group.     

单次胺碘酮预防男性急诊体外循环冠状动脉旁路移植术后心房颤动的疗效评价

目的:探讨单次应用胺碘酮对男性患者行急诊体外循环冠状动脉旁路移植术(ONCABG)后新发心房颤动预防的疗效.方法:50例美国麻醉医师协会(ASA)患者全身状况分级III-IV级急诊行ONCABG的男性患者,均伴有高血压和2型糖尿病病史。随机分为试验组(Y组,n=25)和对照组(C组,n=25)。Y组和C组分别在升主动脉开放前经中心静脉注入0.9%氯化钠液20mL和胺碘酮注射液20mL(3mg/kg)。结果:Y组和C组的术后心房颤动发生率(28%vs.24%),胺碘酮转复率(100%vs.100%),差异无统计学意义,但是多元线性回归显示体外循环时间和术后发生心房颤动会影响患者ICU入住时间(P0.05)。结论:单次静脉预防性应用胺碘酮并不能降低男性患者急诊ONCABG术后心房颤动的发生率;长时间体外循环和术后新发心房颤动是延长患者ICU入住时间的独立危险因素。     

有、无体外循环冠状动脉旁路移植术后房颤原因的分析

目的:比较非体外循环下的冠状动脉旁路移植术(OPCABG)与体外循环下的冠状动脉旁路移植术(ECCABG)后房颤的发生率,并分析其原因。方法:OPCABG组75例,手术在全麻常温下进行;ECCABG组113例,手术在全麻低温体外循环下进行。结果:OPCABG组术后15例(20％)出现房颤,ECCABG组术后31例(27.4％)出现房颤。二组房颤发生率有显著差异(P<0.05)。结论:非体外循环下的冠状动脉旁路移植术术后房颤的发生率低于体外循环下的冠状动脉旁路移植术术后的房颤发生率,但仍有较高的发生率。房颤发生的原因可能是术后侧支循环逐渐关闭,改变心房的血液分布,诱发心房内及其周围组织产生局灶激动,从而发生房颤。     

Predictors of atrial fibrillation after coronary artery bypass graft： a meta-analysis

Objectives Postoperative atrial fibrillation （AF） has been associated with less favorable outcomes in patients undergoing coronary artery bypass graft surgery （CABG） and may result in increased post-operative morbidity and mortality. A systematic review and meta-analysis of published studies was conducted to examine the risk factors of occurrence AF after CABG. Methods Using the Medline database, the Cochrane clinical trials database and online clinical trial databases, we reviewed all randomized controlled trials （RCTs） and observational studies examining the risk factors of occurrence of AF after CABG. We searched for literature published April 2009 or earlier. Results Our review identified 8 studies （observational studies）, involving 14548 patients, that examined the risk factors of occurrence of AF after CABG. Although studies provide conflicting results, the overall outcomes suggests that advanced age, previous hypertension, numbers of bridge vessels may increase the occurrence of AF after CABG, while no significant difference of diabetes, preoperative myocardial infarction, and preoperative medication of 13 -Blocker have been observed between the AF patients and no-AF patiens. Conclusions Patients with advanced age, previous hypertension and more numbers of bridge vessels had higher risk for the occurrence of AF after CABG, and perioperative medication and care must be intensified to decrease the postoperative occurrence ofAF（J Geriatr Cardio12009; 6：162-167）.     

围手术期阿托伐他汀治疗对冠状动脉旁路移植术后心房颤动的控制

目的探讨围手术期口服阿托伐他汀降脂药对冠状动脉旁路移植（coronary artery bypass grafting,CABG）术后患者心房颤动（atrial fibrillation,AF）的控制。方法298例行CABG术连续患者,根据围手术期是否予以阿托伐他汀药物分为他汀组及对照组各149例,分析比较两组术后心房颤动发生情况及超敏C反应蛋白（hs-CRP）、血脂水平变化。结果用统计学软件SPSS13.0处理,计数资料应用χ2检验或校正χ2,计量资料应用t检验,P值〈0.05认为差异有统计学意义。结果他汀组和对照组在病史特点、手术操作及围手术期参数方面无统计学差异。术后房颤65例,总发生率21.8%,他汀组（14.8%）和对照组（28.9%）差异有显著统计学意义（χ2=8.677,P=0.003）。两组相比,他汀组症状性房颤发生率及房颤持续时间较对照组减少,差异有统计学意义（χ2=5.471,P=0.019;t=4.142,P=0.014）。Hs-CRP在两组中变化相似,术后3d水平最高,术后1周逐渐降低,术后3个月均能控制在正常低水平。对照组术后3d及1周较术前相比均有显著升高,差异具有统计学意义（t=1.746和2.818,P〈0.05）。同期比较,他汀组术后3d及1周hs-CRP显著低于对照组（t=16.344和6.029,P〈0.05）。他汀组和对照组血总胆固醇浓度在术后1周及3个月较术前比较均有显著降低（t=1.675和1.376,P〈0.05;t=1.413和1.472,P〈0.05）。结论围手术期口服阿托伐他汀除对CABG术后患者的血脂有效调节外,对全身炎症反应有明显减轻,并可降低术后房颤的发生率并缩短持续时间,且无肝肾功能损伤等并发症。     

体外循环下冠状动脉旁路移植术后新发房颤的危险因素分析

【摘要】 目的 探讨体外循环下冠状动脉旁路移植（on-pump coronary artery bypass grafting,ONCAB）术后新发房颤的危险因素,为ONCAB术后新发房颤的预防和治疗提供参考。方法 收集我院心脏外科2015年1月至2016年5月间357例单纯ONCAB患者的临床资料,根据术后是否发生新发房颤而分为房颤组和非房颤组。对两组患者围术期的临床参数进行统计分析,从而筛选术后新发房颤的独立危险因素。结果 ONCAB术后新发房颤的发生率为23.8%（85例）。单因素分析结果显示,年龄≥65岁（P=0.02）、慢性阻塞性肺疾病病史（P=0.03）及术前左心房内径≥38 mm（P<0.001）与ONCAB术后新发房颤相关。logistic多因素回归分析显示,年龄≥65岁(OR=1.720, P=0.039)、慢性阻塞性肺疾病病史(OR=11.924, P=0.032)及左心房内径≥38 mm(OR=2.735, P<0.001)是ONCAB术后患者发生新发房颤的独立危险因素。结论 高龄（≥65岁）、慢性阻塞性肺疾病病史及左心房内径增大（≥38 mm）与ONCAB术后新发房颤相关,是潜在的预测因子。     

艾司洛尔预防冠状动脉旁路移植围术期心房颤动的作用

目的探讨非体外循环冠状动脉旁路移植手术(OPCAB)围术期并发心房颤动(房颤)时艾司洛尔的预防和治疗作用。方法分析OPCAB围术期70例使用短效β受体阻滞剂患者(艾司洛尔组)和同期115例未使用艾司洛尔患者(对照组)OPCAB围术期房颤发生的情况。艾司洛尔组于手术开始前持续输注艾司洛尔3～5μg·kg~(-1)·min~(-1)至手术结束。结果艾司洛尔组术后房颤的发生率明显低于对照组(7.1%比23.5%,P<0.05)。结论术中应用低剂量艾司洛尔静脉输注能够安全有效地降低OPCAB患者术后房颤的发生率。     

术前低剂量胺碘酮预防非体外循环冠状动脉旁路移植术后心房颤动

目的 前瞻性的评估术前低剂量胺碘酮预防非体外循环冠状动脉旁路移植术后心房纤颤(房颤)的安全性、耐受性和有效性. 方法 将200例择期行非体外循环冠状动脉旁路移植手术(OPCAB)治疗的冠状动脉粥样硬化性心脏病患者随机分成研究组和对照组.对照组100例,术前给予常规药物和安慰剂;研究组100例,术前给予常规药物和低剂量胺碘酮,术后两组均用常规药物.结果 研究组的房颤发生率(15%)、房颤时最大心室率(126.0±20.8)次/min,房颤持续时间(8.0±8.6)h均低于对照组的房颤发生率((41%),(χ2=16.766,P=0.000]、房颤时最大心室率((150.0±25.6)次/min,t=0.478,P=0.017]以及房颤持续时间[(12.0±9.6)h,t=0.439,P=0.019].本实验结果 显示研究组药物不良反应的发生较对照组差异无统计学意义(P均0.05).结论 术前预防性应用低剂量胺碘酮能安全有效减少房颤发生率,缩短房颤持续时间,并能降低术后房颧最大心室率,减轻临床症状.     

Statin therapy in the prevention of atrial fibrillation in the early postoperative period after coronary artery bypass grafting: A meta-analysis

BackgroundPostoperative atrial fibrillation (POAF) is observed in the early postoperative period in approximately every third patient after coronary artery bypass grafting (CABG). The pathogenesis of POAF is multifactorial and is not yet fully studied. In many studies, postoperative inflammatory response has been extensively investigated as a potential basic factor of POAF. It is known that statins have anti-inflammatory properties. In some studies, pre- and perioperative use of statins has shown the decrease of incidence of POAF after CABG.ObjectiveWe conducted meta-analysis of randomized and observational studies of efficiency of statin therapy for the prevention of POAF after CABG.Material and methodsThe meta-analysis included 15 clinical trials of statins in 9369 patients with performed CABG during the past 10 years. 5598 patients (59.75%) were taking statins and 3771 patients (40.25%) were not taking statins. The following outcomes observed in the early postoperative period were studied: incidence of POAF, total mortality rate, total stroke rate, and total rate of myocardial infarction. The duration of hospitalization and levels of inflammatory markers before and after CABG were also assessed.ResultsThe statin therapy reduced the incidence of POAF after CABG (OR = 0.48, 95% CI: 0.35–0.67, P < 0.001). Moreover, the statin therapy decreased the total length of hospital stay and levels of inflammatory markers in the blood serum.ConclusionThe results of our meta-analysis leave no doubt in the presence of anti-inflammatory and anti-arrhythmic effect of statin therapy. We confirmed the overall positive role of using statins before CABG for POAF prevention.     

Naproxen as prophylaxis against atrial fibrillation after cardiac surgery: the NAFARM randomized trial

Purpose

We sought to assess the effect of naproxen versus placebo on prevention of atrial fibrillation after coronary artery bypass graft (CABG) surgery.

Methods

In this randomized, double-blind, placebo-controlled, single-center trial of 161 consecutive patients undergoing CABG surgery, patients received naproxen 275 mg every 12 hours or placebo at the same dosage and interval over 120 hours immediately after CABG surgery. The primary outcome was the occurrence of atrial fibrillation in the first 5 postoperative days.

Results

The incidence of postoperative atrial fibrillation was 15.2% (12/79) in the placebo versus 7.3% (6/82) in the naproxen group (P = .11). The duration of atrial fibrillation episodes was significantly lower in the naproxen (0.35 hours) versus placebo group (3.74 hours; P = .04). There was no difference in the overall days of hospitalization between placebo (17.23 ± 7.39) and naproxen (18.33 ± 9.59) groups (P = .44). Intensive care unit length of stay was 4.0 ± 4.57 days in the placebo and 3.23 ± 1.25 days in the naproxen group (P = .16). The trial was stopped by the data monitoring committee before reaching the initial target number of 200 patients because of an increase in renal failure in the naproxen group (7.3% vs 1.3%; P = .06).

Conclusions

Postoperative use of naproxen did not reduce the incidence of atrial fibrillation but decreased its duration, in a limited sample of patients after CABG surgery. There was a significant increase in acute renal failure in patients receiving naproxen 275 mg twice daily. Our study does not support the routine use of naproxen after CABG surgery for the prevention of atrial fibrillation.