Predictors of atrial fibrillation after off-pump coronary artery bypass graft surgery.
OBJECTIVE
Atrial fibrillation is the most common complication after coronary artery bypass graft surgery. This arrhythmia may lead to hemodynamic compromise, prolonged hospitalization, and increased risk for cerebral thromboembolism. Older age is the only variable consistently associated with the development of postoperative atrial fibrillation; however, no strong predictive model exists. The purpose of this study was to identify perioperative characteristics associated with new-onset atrial fibrillation in patients undergoing off-pump coronary artery bypass grafting.


METHODS
Prospective, observational.


METHODS
University tertiary care hospital.


METHODS
One hundred sixty consecutive patients undergoing off-pump coronary artery bypass grafting.


METHODS
None.


RESULTS
Incidence of postoperative atrial fibrillation was the major outcome. Atrial fibrillation occurred in 33 patients (20.6%). Multivariate analysis identified reintervention (odds ratio 26.8), revascularization of the ramus medianus (odds ratio 3.9), and age (odds ratio 1.069 per year) as the only independent predictors of postoperative atrial fibrillation. All patients were in sinus rhythm at hospital discharge. One hospital death was noted.


CONCLUSIONS
Despite the less invasive approach, the incidence of postoperative atrial fibrillation is high after off-pump coronary artery bypass grafting. Older age, grafting of the ramus medianus, and a redo operation were predictors of new-onset postoperative atrial fibrillation. It is possible that left atrial stretching with heart dislocation during revascularization of the lateral wall could lead to postoperative atrial fibrillation.
Zangrillo
Alberto
A
Department of Cardiovascular Anesthesia, IRCCS San Raffaele Hospital, Milan, Italy.
Landoni
Giovanni
G
Sparicio
Donatella
D
Benussi
Stefano
S
Aletti
Giacomo
G
Pappalardo
Federico
F
Fracasso
Giulia
G
Fano
Greta
G
Crescenzi
Giuseppe
G
D000368:Aged; D001281:Atrial Fibrillation / Q000453:epidemiology* / Q000209:etiology; D047549:Coronary Artery Bypass, Off-Pump / Q000009:adverse effects / Q000379:methods; D005260:Female; D006801:Humans; D015994:Incidence; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011183:Postoperative Complications / Q000453:epidemiology*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors