title: Does preoperative atrial fibrillation influence early and late outcomes of coronary artery bypass grafting?
abstract: OBJECTIVE
  The study objective was to describe the independent effect of preoperative atrial fibrillation on the outcome of coronary artery bypass grafting, including the causes of death (cardiac vs noncardiac).
  
  
  METHODS
  We analyzed the outcome of patients with preoperative atrial fibrillation who underwent on-pump coronary artery bypass grafting between 1993 and 2002 and compared them with matched controls in sinus rhythm; matching variables were age, gender, ejection fraction, and numbers of diseased coronary arteries and distal anastomoses. Direct patient follow-up focused on late complications and reinterventions, and we investigated causes for all deaths.
  
  
  RESULTS
  Operative mortality (1.6% vs 1.9%, P = .79) was similar in patients with preoperative atrial fibrillation (n = 257) compared with patients in sinus rhythm (n = 269). The patients with atrial fibrillation had longer hospital stays (9 +/- 6 days vs 8 +/- 6 days, P = .0008) and a trend to more frequent early readmissions (13% vs 9%, P = .08). During follow-up (median 6.7 years, maximum 12 years), late hospital admission was more frequent in patients with atrial fibrillation (59% vs 31%, P < .0001). Risk of late mortality (all causes) in patients with atrial fibrillation was increased by 40% compared with patients in sinus rhythm (P = 0.02), and the late cardiac death rate in the atrial fibrillation group was 2.8 times that of the sinus rhythm group (P = .0004). Major adverse cardiac events occurred in 70% of patients with preoperative atrial fibrillation compared with 52% of patients in preoperative sinus rhythm (P < .0001). Subsequent rhythm-related intervention, including pacemaker implantations, was more common in the atrial fibrillation group (relative risk = 2.1, P = .0027).
  
  
  CONCLUSIONS
  Uncorrected preoperative atrial fibrillation in patients undergoing coronary artery bypass grafting is associated with increased late cardiac morbidity and mortality and poor long-term survival. These data support consideration of atrial fibrillation surgery at the time of coronary artery bypass grafting.
authors.affiliation: Division of Cardiovascular Surgery, Mayo Clinic College of Medicine, Rochester, Minn, USA. dngaage@yahoo.com
authors.forename: Dumbor L
authors.initials: DL
authors.lastname: Ngaage
authors.forename: Hartzell V
authors.initials: HV
authors.lastname: Schaff
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Mullany
authors.forename: Thoralf M
authors.initials: TM
authors.lastname: Sundt
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Dearani
authors.forename: Sunni
authors.initials: S
authors.lastname: Barnes
authors.forename: Richard C
authors.initials: RC
authors.lastname: Daly
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Orszulak
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000150:complications*; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000401:mortality*; D003327:Coronary Disease / Q000150:complications* / Q000601:surgery; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D008297:Male; D011183:Postoperative Complications; D015996:Survival Rate; D016896:Treatment Outcome