BJA Advance Access originally published online on April 2, 2007
British Journal of Anaesthesia 2007 98(5):575-580; doi:10.1093/bja/aem067
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Predictors of atrial fibrillation after off-pump coronary artery bypass graft surgery
1 Department of Anesthesiology and Intensive Care, Kyoto Prefectural University of Medicine, Kawaramachi Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
2 Department of Anesthesia, Yamanashi University, and the Outcomes Research Group, Japan
3 Department of Anesthesiology and Intensive Care, Kyoto Prefectural University of Medicine, and the Outcomes Research Group, Japan.
* Corresponding author: Department of Anesthesiology and Intensive Care, Kyoto Prefectural University of Medicine, Kawaramachi Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan. E-mail: nakajima{at}koto.kpu-m.ac.jp
Background: Postoperative atrial fibrillation (AF) is one of the most common complications after cardiothoracic surgery and is associated with an increased risk of stroke, and longer hospital stay. The pathophysiology of postoperative AF is uncertain, and its prevention remains unsatisfactory. Many previous studies have examined the predictors of AF after on-pump coronary artery bypass graft surgery (CABG), but there are few reports after off-pump CABG.
Methods: The aim of the present prospective observational study, in which 296 consecutive patients were enrolled, was to elucidate the predictors of AF after off-pump CABG. The association of perioperative factors with AF was investigated using univariate analysis. Significant variables were included into a stepwise logistic regression model to ascertain their independent influence on the occurrence of AF.
Results: The incidence of AF was 32%. AF prolonged the time until patients were fit for discharge by 3 days (P < 0.01). Stepwise multivariate analysis identified increasing age [odds ratio (OR) 1.44 per 10-yr increase; 95% confidence interval (CI) 1.06–1.95], intraoperative average core temperature (OR 1.64; 95% CI 1.05–2.56), the average cardiac index in the intensive care unit (OR 0.37; 95% CI 0.19–0.71), and intraoperative fluid balance (OR 0.96 per 100-ml increase; 95% CI 0.93–0.99) as independent predictors of postoperative AF.
Conclusion: Our present findings indicate that ageing, the intraoperative fluid balance, and postoperative cardiac index are associated with the onset of AF after off-pump CABG.
Keywords: anaesthesia, cardiovascular; atrial fibrillation, arrhythmia; complications, perioperative; surgery, cardiovascular
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