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Eur J Cardiothorac Surg 1999;16:435-439
© 1999 Elsevier Science NL

Perioperative clinical predictors of atrial fibrillation occurrence following coronary artery surgery

Valentino Ducceschi, Antonello D'Andrea, Biagio Liccardo, Alfonso Alfieri, Berardo Sarubbi, Marisa De Feo, Lucio Santangelo, Maurizio Cotrufo

Istituto Medico-Chirurgico di Cardiologia, Piazza, L. Miraglia, 80138 Napoli, Italy

Corresponding author. Present address: Corso Europa 72, 80127, Naples, Italy. Tel.: +39-081-643-055; fax: +39-081-714-5205
e-mail: adandrea{at}synapsis.it

Objective: Atrial fibrillation (AF) is the most frequently encountered arrhythmic complication associated with coronary surgery. The aim of this paper was then to identify the clinical predictors of post-CABG AF occurrence. Methods: 150 consecutive patients were included in this study and divided into two groups according to the absence (SR group, 104 male and 22 female, age 58.4±8.8 years) or presence (AF group, 23 male and 1 female, age 65.4±6.3 years) of post-CABG AF. Forty-seven perioperative variables were considered. Results: After univariate analysis, advanced age (SR vs. AF: 58.4±8.8 vs. 65.4±6.3, P<0.001), an increased BMI (SR vs. AF: 26.1±2.7 vs. 27.4±2.5, P=0.026), a prior history of paroxysmal AF (SR vs. AF: 3.2% vs. 16.7%, P=0.028), left atrial enlargement (SR vs. AF: 21.1% vs. 70.8%, P<0.001) and a more severe coronary artery disease (CAD) (SR vs. AF: no. of diseased vessels: 2.42±0.7 vs. 2.91±0.3, P=0.001; three-vessel CAD (54.1% vs. 91.3%, P=0.002) were the only factors that statistically differed between the groups. Multivariate logistic regression analysis identified left atrial enlargement (P<0.0001), a prior history of paroxysmal AF (P=0.007) and a more severe CAD (P=0.0047) to be independent correlates for AF. Conclusions: Post-CABG AF seems to require a well definite anatomical and electrical substrate that is generated by increased left atrial dimensions, a greater extension of coronary lesions and a possible electrical remodeling consequent to prior repetitive episodes of paroxysmal AF.

Key Words: Atrial fibrillation • Coronary artery bypass graft • Postoperative arrhythmia




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