medigraphic.com
ISSN 2078-7170 (Electronic)

2014, Number 2

<< Back Next >>

CorSalud 2014; 6 (2)

Risk factors for postoperative atrial fibrillation in cardiac surgery

Rodríguez RE, de Arazoza HA, Vázquez CF, Moreno-Martínez FL

Language: Spanish
References: 28
Page: 174-180
PDF size: 313.72 Kb.


ABSTRACT

Introduction: The advent of new techniques of percutaneous intervention, the optimization of pharmacological behavior and the use of new surgical techniques (con-ventional, minimally invasive and videoassisted) have resulted in ever more difficult cases being treated in the operating room with an increase in the incidence of postoperative atrial fibrillation.
Objectives: To analyze the association among some variables and the incidence of this arrhythmia in cardiovascular surgery.
Method: A retrospective analysis was conducted with the last 100 patients of both sexes, aged 18 and over, operated in the Cardiovascular Surgery Service of CIMEQ Cardiology Hospital, between October 2008 and February 2010. 27 variables arranged in four groups were analyzed and their relationship with postoperative atrial fibrillation was determined.
Results: 37% of the patients analyzed presented this type of atrial fibrillation, which was more frequent in patients with mixed (80%) and double valve disease (66.66 %). Of the clinical variables only previous atrial fibrillation, mitral valve disease, age over 65, hemodynamic instability, previous myocardial infarction and III or IV functional class were significant. None of the studied electrocardiographic variables were significantly associated with the occurrence of postoperative atrial fibrillation. All echocardiographic variables (dilated left ventricle and atrium, dilated right atrium and ejection fraction below 55 %), and six of the variables that are typical of surgery (cardiopulmonary bypass, recovery from cardiac arrest in atrial or ventricular fibrillation, use of amines in trans or postoperative period, over 120 minutes of aortic clamping, double valve disease and mixed cases) were significantly associated with the occurrence of this arrhythmia.
Conclusions: The clinical variables highly associated with atrial fibrillation are less significant than the variables typical of surgery, in the case of postoperative atrial fibrillation.


REFERENCES

  1. Moreno-Martínez FL, Groning González DV, Fleites Cárdenas HA, Lagomasino Hidalgo A, González Al-fonso O, Ramos Ramírez RR, et al. Reversión de fibrilación auricular paroxística con amiodarona después de una revascularización miocárdica qui-rúrgica sin bomba. Rev Fed Arg Cardiol. 2005;34(1): 118-23.

  2. Gambarte AJ. Génesis de la Fibrilación auricular. Potenciales mecanismos involucrados. Rev Fed Arg Cardiol. 2004; 33(3): 364-75.

  3. Lewis T. Report CXIX. Auricular fibrillation: a com-mon clinical condition. Br Med J. 1909;2(2552): 1528.

  4. Lewis T. The mechanism and graphic registration of the heartbeat. London: Shaw & Sons, 1925.

  5. Bellet S. Clinical disorders of the heartbeat. 3ra. ed. Philadelphia: Lea & Febiger, 1971.

  6. Camm J, Kirchhof P, Lip GYH, Schotten U, Savelieva I, Ernst S, et al. Guías de práctica clínica para el manejo de la fibrilación auricular. Rev Esp Cardiol. 2010;63(12):1483.e1-e83.

  7. Prystowsky EN, Katz AM. Atrial fibrillation. En: To-pol EJ, ed. Textbook of Cardiovascular Medicine. Philadelphia: Lippincott-Raven; 1998. p. 1661.

  8. Allessie MA, Boyden PA, Camm AJ, Kléber AG, Lab MJ, Legato MJ, et al. Pathophysiology and preven-tion of atrial fibrillation. Circulation. 2001;103(5): 769-77.

  9. Karmelic SC. Fibrilación auricular: estado actual. Rev Méd Clín Condes. 2008;19(1):32-8.

  10. 10.Echahidi N, Pibarot P, O’Hara G, Mathieu P. Me-chanisms, prevention, and treatment of atrial fi-brillation after cardiac surgery. J Am Coll Cardiol. 2008;51(8):793-801.

  11. 11.Kalavrouziotis D, Buth KJ, Ali IS. The impact of new-onset atrial fibrillation on in-hospital mortality following cardiac surgery. Chest. 2007;131(3):833-9. 12.Hohnloser SH. Nuevas perspectivas farmacológicas en pacientes con fibrilación auricular: el ensayo ATHENA. Rev Esp Cardiol. 2009;62(5):479-81.

  12. 13.Wolf PA, Mitchell JB, Baker CS, Kannel WB, D’Agos-tino RB. Impact of atrial fibrillation on mortality, stroke, and medical costs. Arch Intern Med. 1998; 158(3):229-34.

  13. 14.Cea-Calvo L, Redón J, Lozano JV, Fernández-Pérez C, Martí-Canales JC, Llisterri JL, et al. Prevalencia de fibrilación auricular en la población española de 60 o más años de edad. Estudio PREV-ICTUS. Rev Esp Cardiol. 2007;60(6):616-24.

  14. 15.Kannel WB, Wolf PA, Benjamin EJ, Levy D. Preva-lence, incidence, prognosis, and predisposing con-ditions for atrial fibrillation: population-based esti-mates. Am J Cardiol. 1998;82(8A):2N-9N.

  15. 16.Moro Serrano C, Hernández-Madrid A. Fibrilación auricular: ¿estamos ante una epidemia? Rev Esp Cardiol. 2009;62(1):10-4.

  16. 17.Furberg CD, Psaty BM, Manolio TA, Gardin JM, Smith VE, Rautaharju PM. Prevalence of atrial fi-brillation in elderly subjects (the Cardiovascular Health Study). Am J Cardiol. 1994;74(3):236-41.

  17. 18.Kannel WB, Benjamin EJ. Status of the epidemiolo-gy of atrial fibrillation. Med Clin North Am. 2008; 92(1):17-40.

  18. 19.Levy S, Maarek M, Coumel P, Guize L, Lekieffre J, Medvedowsky JL, et al. Characterization of different subsets of atrial fibrillation in general practice in France: the ALFA study. The College of French Car-diologists. Circulation. 1999;99(23):3028-35.

  19. 20.Brugada R, Tapscott T, Czernuszewicz GZ, Marian AJ, Iglesias A, Mont L, et al. Identification of a genetic locus for familial atrial fibrillation. N Engl J Med. 1997;336(13):905-11.

  20. 21.Villareal RP, Hariharan R, Liu BC, Kar B, Lee VV, Elayda M, et al. Postoperative atrial fibrillation and mortality after coronary artery bypass surgery. J Am Coll Cardiol. 2004;43:742-8.

  21. 22.Archbold RA, Schilling RJ. Atrial pacing for the pre-vention of atrial fibrillation after coronary artery bypass graft surgery: a review of the literature. Heart. 2004;90:129-33.

  22. 23.Maisel WH, Rawn JD, Stevenson WG. Atrial fi-brillation after cardiac surgery. Ann Intern Med. 2001;135:1061-73.

  23. 24.Mathew JP, Fontes ML, Tudor IC y col: A multi- center risk index for atrial fibrillation after cardiac surgery. JAMA. 2004;291:1720-9.

  24. 25.Hogue CW, Creswell LL, Gutterman DD, Fleisher LA; American College of Chest Physicians. Epidemiology, mechanisms, and risks: American College of Chest Physicians guidelines for the prevention and ma-nagement of postoperative atrial fibrillation after cardiac surgery. Chest. 2005;128(2 Suppl):9S-16S.

  25. 26.Creswell LL, Karis NJ. Complications of cardiopul-monary bypass and cardioplegia. En: Little AG, Merrill WH, eds. Complications in Cardiothoracic Surgery: Avoidance and Treatment. 2da ed. Oxford: Wiley-Blackwell, 2009; p. 74-142.

  26. 27.Mota AL, Rodrigues AJ, Evora PR. Adult cardiopul-monary bypass in the twentieth century: science, art or empiricism? Rev Bras Cir Cardiovasc. 2008; 23(1):78-92.

  27. 28.Rinder CS. Hematologic effects and coagulopathy. En: Gravlee GP, Davis RF, Stammers AH, Unger-leider RM. Cardiopulmonary bypass: Principles and practice. 3ra. ed. Philadelphia: Lippincott Williams & Wilkins, 2008; p. 439-58.

  28. 29.Zakkar M, Taylor K, Hornick PI. Immune system and inflammatory responses to cardiopulmonary by-pass. En: Gravlee GP, Davis RF, Stammers AH, Un-gerleider RM. Cardiopulmonary bypass: Principles and practice. 3ra. ed. Philadelphia: Lippincott Williams & Wilkins, 2008; p. 321-37.




2020     |     www.medigraphic.com