Reduced incidence of atrial fibrillation after cardiac surgery by continuous wireless monitoring of oxygen saturation on the normal ward and resultant oxygen therapy for hypoxia.
OBJECTIVE
Monitoring of cardiac surgical patients after transfer from the intensive care unit to the normal ward is incomplete. Undetected hypoxia, however, is known to be a risk factor for occurrence of atrial fibrillation. We have utilized Auricall for continuous wireless monitoring of oxygen saturation and heart rate until discharge. The object of the study was to analyze if oxygen therapy as a result of Auricall alerts of hypoxia can decrease the incidence of postoperative atrial fibrillation.


METHODS
Auricall is a wireless portable pulse oximeter. An alert is generated depending on preset threshold values (heart rate, oxygen saturation). Over a period of 6 months, 119 patients were monitored with the Auricall following coronary artery bypass graft and/or valve surgery. Oxygen therapy was started subsequent to an oxygen saturation below 90%. These patients were compared with a cohort of 238 patients from the time period before availability of Auricall. The patient characteristics were comparable in both groups. In a retrospective study, the incidence of atrial fibrillation was measured in both groups.


RESULTS
The postoperative AF was observed in 22/119 patients (18%) in group I and in 66/238 patients (28%) in group II. This difference between the two groups approached significance (p=0.056). In the subgroup of patients with coronary artery bypass graft with our without simultaneous valve surgery (n=312), Auricall monitoring resulted in a significantly reduced incidence of atrial fibrillation (14% vs 26%, p=0.016).


CONCLUSIONS
Continuous monitoring of oxygen saturation on the normal ward and subsequent oxygen therapy for hypoxia can reduce the incidence of atrial fibrillation in a subgroup of patients after cardiac surgery. Prospective randomized trials are warranted to confirm these data.
Kisner
Dilek
D
Clinic for Cardiovascular Surgery, University Hospital Zurich, Rämistr. 100, Zurich CH-8091, Switzerland.
Wilhelm
Markus J
MJ
Messerli
Michael S
MS
Zünd
Gregor
G
Genoni
Michele
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000209:etiology / Q000517:prevention & control*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D001026:Coronary Artery Bypass; D005260:Female; D006801:Humans; D000860:Hypoxia / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D010100:Oxygen / Q000097:blood*; D010102:Oxygen Inhalation Therapy; D011182:Postoperative Care / Q000379:methods; D012307:Risk Factors; D013686:Telemetry / Q000379:methods
D010100:Oxygen