Atrial fibrillation after beating heart surgery

Postoperative atrial fibrillation (AF) is a frequent adverse event after co ronary artery bypass grafting (CABG) and may negatively affect the early cl inical outcome. We sought to investigate the risk factors, prevalence, and prognostic implications of postoperative AF in patients submitted to CABG w ithout cardiopulmonary bypass (off-pump). The study population comprised 96 9 patients, 645 men (67%) and 324 women (33%) who had off-pump CABG at the Washington Hospital Center from January 1987 to May 1999. Preoperative AF p atients were excluded (n = 15). Two hundred six patients (age 69 +/- 10 yea rs, 137 men [66%]) developed AF, whereas 763 patients (age 61 +/- 12 years, 508 men [67%]) did not. predictors of AF included age >75 years (odds rati o [OR] 3.0, 95% confidence interval [CI] 1.9 to 4.5; p <0.001), history of stroke (OR 2.1, CI 1.2 to 3.7; p 0.007), postoperative pleural effusion req uiring thoracentesis (OR 3.2, CI 1.0 to 9.4; p 0.03), and postoperative pul monary edema (OR 5.1, CI 1.2 to 21; p = 0.02). Minimally invasive direct CA BG was associated with a lower incidence of AF (OR 0.4, CI 0.3 to 0.7; p <0 .001). AF was associated with a prolonged postoperative hospital stay (9 +/ - 6 days AF vs 6 +/- 5 days no AF, p <0.001). In-hospital mortality was sig nificantly higher in AF patients (3% AF vs 1% no AF, p = 0.009). patients w ith persistent AF had a higher postoperative in-hospital stroke rate than p atients without persistent AF (9% vs 0.6%, p <0.001). AF after beating hear t surgery is associated with a higher in-hospital morbidity, mortality, and prolonged hospital stay. A minimally invasive surgical approach (minimally invasive direct CABG) is associated with a lower risk of AF. (C) 2000 by E xcerpta Medica, Inc.