Preoperative Prophylaxis Can Decrease Rates of Atrial Fibrillation in Open Heart Surgery: A Retrospective Study (original) (raw)
Related papers
Beta-blocker effects on postoperative atrial fibrillation
European Journal of Cardio-Thoracic Surgery, 1997
Objectives: To determine whether restarting of Beta Blocker following cardiac surgery would reduce the incidence and the severity of post-operative atrial fibrillation (AF). Methods: 210 patients who underwent elective coronary artery bypass grafting were randomized to control (C) (n=105) and Beta Blockers (BB) (n= 105) groups. Preoperatively all patients were on one type or another of betablockers. Postoperatively only the (BB) group received the medication. Both groups were well matched and had the same cardioplegic technique. Results: It was found that; (1) post op (AF) developed in 40 patients of group (C) and in 18 patients of group (BB) P value B0.02. (2) 73% of (AF) patients in group (C) and 81% in group (BB) were older than 70 years of age. (3) 76% of the (AF) in (BB) group versus 43% in (C) group were converted to sinus rhythm or to a stable controlled rhythm within 24 h or less. P value B0.01. Conclusions: the results indicate that restarting the Beta Blockers in the post-operative period after coronary bypass grafts significantly control the incidence and the severity of atrial fibrillation. Also it confirms the strong relation between the older age and (AF) occurrence.
Annals of Noninvasive Electrocardiology, 2013
Background: Atrial fibrillation/flutter (AF) is a common complication of open heart surgery and ACC/AHA guidelines strongly recommend the use of prophylactic beta-blockers (BB) for its prevention. Several recent studies, however, have failed to show the desired protective effects of BB against post-coronary artery bypass grafting (CABG) AF. As the protocols of CABG, medical management of CAD (coronary artery disease) and demographic features of the patients undergoing open heart surgery have evolved significantly over the last two decades, we decided to perform a review of evidence from latest randomized controlled trials (RCTs) to confirm the efficacy of prophylactic BB. Methods: We searched for RCTs comparing the efficacy of prophylactic BB versus placebo/control against post-CABG AF. We limited our search to 1995 till present to reflect ongoing advancements in the protocols of CABG and the medical management of CAD. Initially, 34 trials were selected; however after certain exclusions only 10 RCTs were included in the final analysis. Results: Prophylactic BB decreased the incidence of post-CABG AF from 32.8% in the control group to 20% in the prophylactic group with risk ratio (RR) of 0.50 with 95% CI of 0.36-0.69, P value < 0.001. In a subgroup analysis, carvedilol appears to be superior to metoprolol for the prevention of postoperative AF. Conclusions: Despite several limitations, this analysis confirms the efficacy of prophylactic BB against post-CABG AF in this era. We recommend continuing perioperative BB in the open heart surgery patients in the absence of contraindications.
2020
Postoperative atrial fibrillation is a very common surgical complication encountered in patients undergoing Cardiac Surgery including Coronary Artery Bypass Grafting and Valvular Surgeries, which leads to increase hospital stay and burden on health care providers. The aim of this review study was to to determine the effectiveness of current management for the Prophylaxis of Postoperative Atrial Fibrillation in Cardiac Surgeries and to propose a possible prophylaxis to prevent POAF. 21 research papers were selected and brought under review after carefully considering the current day evidence for prophylaxis and each having its scientific evidence and background. The papers were carefully reviewed and findings were given in favour of Amiodarone, Ascorbate and B-Blockers including Sotalol. This can rightly be concluded from this study that prophylaxis with Ascorbate for 5 days prior to cardiac surgery along with the use of Amiodarone 1.2 g before surgery and 600 mg/day till 3rd post op...
Seminars in Thoracic and Cardiovascular Surgery, 2023
Objective: The impact of pre-existing atrial fibrillation on the long-term outcome in patients after off-pump coronary revascularisation is not well known. This study aims to determine the independent effects of preoperative atrial fibrillation on the early and late outcomes of off-pump coronary artery bypass surgery. Methods: A total of 513 patients undergoing isolated coronary artery bypass surgery using off-pump approach between 2000 and 2005 were studied. Twenty-six of them (5.1%) had preoperative atrial fibrillation (15 had paroxysmal atrial fibrillation and 11 had persistent or permanent atrial fibrillation) and the other 487 patients were in normal sinus rhythm. Early and late outcomes were compared retrospectively between patients with preoperative atrial fibrillation and patients in sinus rhythm. The median follow-up period for the entire study population was 3.3 AE 2.7 years. Results: The baseline characteristics of the patients with preoperative atrial fibrillation were generally similar to those of patients in sinus rhythm. However, the patients with atrial fibrillation had a significantly lower left ventricular ejection fraction compared with those in sinus rhythm (50 AE 15 vs 56 AE 12%, p = 0.03). The mean age of the atrial fibrillation group was almost 3 years more than that of the sinus rhythm group. Operative mortality was similar in patients with atrial fibrillation (3.8%) and those in sinus rhythm (1.0%). Ten patients developed cerebral infarction within 7 days after surgery, including one patient (3.8%) from the atrial fibrillation group and nine patients (1.8%) from the sinus rhythm group. Long-term survival was significantly decreased in the atrial fibrillation group (5-year survival: 70 AE 9.6% vs 87 AE 1.8%; p = 0.0018). Freedom from cerebral complications was also significantly decreased in the atrial fibrillation group (5-year survival: 85 AE 8.3% vs 95 AE 1.2%; p = 0.0009), but there were no differences in cardiac death and major cardiac adverse events. On Cox proportional hazards regression analysis, preoperative atrial fibrillation was a significant adverse predictor for survival (hazard ratio = 3.0, 95% confidence intervals (CIs) 1.3-6.9; p = 0.009) and independent predictor of late cerebral infarction (hazard ratio = 6.2, 95% CIs 2.0-19.3; p = 0.0002). Conclusions: Uncorrected preoperative atrial fibrillation is strongly associated with poor long-term survival and increased late cerebral complications after off-pump coronary artery bypass surgery. Concomitant atrial fibrillation surgery should be considered to improve the longterm results of surgical revascularisation.
Current Vascular Pharmacology, 2014
Atrial fibrillation (AF) after isolated coronary surgery in many aspects remains an unsolved issue and a source of morbidity . Postoperative AF (POAF) has significant adverse effects and prolongs hospital stay, leading to relevant disease burden and medical costs . Its consequences are substantial: this arrhythmia dramatically increases early and late mortality . Patients affected by POAF are at risk of fatal embolic events, therefore, a strict postoperative surveillance is widely recommended .
Background: The reported incidence of AF after CABG surgery varies from 20 to 40%, with the arrhythmia usually occurring between second and fourth postoperative days. Postoperative AF after CABG was associated with greater in-hospital mortality and worse survival at long-term follow-up. Therefore, intensive attention has focused on the prevention of AF in high-risk patients. Many perioperative factors have been suggested to increase the incidence of postoperative AF after conventional CABG. In this study we are trying to examine some of these risk factors as predictors for Post-operative AF in our patients. In this study, our aim was to identify the perioperative predictors of AF in our patients who underwent Coronary Artery Bypass Grafting. Methods: Our Patients were divided into two groups; Group A included patients who did not develop PO AF (168 patients) and Group B patients who developed PO AF (84 patients). Perioperative Data, including gender, age, demographic variables and postoperative morbidity and mortality were extracted from the medical records. Results: This retrospective cohort study was conducted on 252 consecutive adult patients underwent CABG, in King Faisal Specialist Hospital and Research Center in Jeddah, Saudi Arabia. The mean age for patients with PO AF was 65 years (P = .0001). Eight-three patients (49.4%) were diabetics in group A and 56 patients (66.7%) in group B (P = .0001). Patients who developed POAF had a lower ejection fraction (44.8 ± 5.7%) (P = .0001), diastolic dysfunction (P = .0001), Larger Left atrial volume (P = .0001). Bleeding requiring reopening for exploration and Postoperative shock were identified as significant predictors for POAF. Multivariate logistic regression (odds ratio, ±95% CI, P value) was performed to identify the effect of age, preoperative heart rate, ejection fraction, postoperative bleeding, Shock, ventilator time, Sensitivity was 89.5%, specificity was 94.6%, positive predictive value was 89.5%, and negative predictive value was 94.6%.
International Journal of Cardiology, 2009
Although all beta blockers appear to be effective in the prevention of postoperative atrial fibrillation (AF) following coronary artery bypass surgery (CABG), carvedilol was found to be much more effective than metoprolol in this respect as the current study clearly delineated. We believe that the ongoing COMPACT trial will answer the question of whether or not carvedilol is more superior than metoprolol to prevent postoperative AF in patients undergoing CABG.
Atrial fibrillation (AF) after coronary artery bypass graft (CABG) is a common complication with potentially higher risk of adverse outcome and prolonged hospital stay. To determine the impact of postoperative AF (POAF) on long-term outcome in a large cohort of patients who underwent CABG. We conducted an observational cohort study of 989 patients who underwent isolated CABG with more than 5-year follow-up. Patient divided in two groups: patients with and without POAF. In this study, atrial fibrillation developed after CABG in 156 patients (15.8%). Patients with POAF were generally older (P = 0.001) and presented more often with comorbidities including congestive heart failure (P = 0.001), hypertension (P = 0.001), peripheral vascular disease (P = 0.001), hyperlipidemia (P = 0.009), and renal failure (P = 0.001). Five-year mortality was observed in 23 (2.3%) patients. Patients with POAF had higher five-year mortality rate than those without POAF. Multivariate logistic analysis showe...