Atrial fibrillation after coronary artery bypass grafting. Is it a disorder of the elderly?

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Atrial fibrillation after coronary artery bypass grafting. Is it a disorder of the elderly?

JA Fuller, GG Adams and B Buxton
Open Heart Surgery Unit, Epworth Hospital, Richmond, Victoria, Australia.

A total of 1666 patients undergoing isolated coronary artery bypass were studied for the occurrence of postoperative atrial fibrillation. Possible associations of this arrhythmia with various preoperative, intraoperative, and postoperative factors were studied by univariate (chi 2 and t tests) and multivariate (logistic regression) analyses. The overall incidence of postoperative atrial fibrillation was 28.4%, with the major occurrence 2 days after the operation. Both univariate and multivariate studies indicated the patient's age to be the dominant factor promoting postoperative atrial fibrillation, with an increasing prevalence in older patients (p = 0.0001). Multivariate analysis showed that postoperative beta-blocker therapy conveyed considerable protection against postoperative atrial fibrillation (p = 0.001) but was less effective in the older patients. Men were more prone to this arrhythmia (p = 0.02). Although these associations appeared significant, the logistic model proved to be a poor predictor of postoperative atrial fibrillation, which suggests that other factors not studied, or mere chance, may also be responsible.

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				D. Amar, W. Shi, C. W. Hogue Jr, H. Zhang, R. S. Passman, B. Thomas, P. B. Bach, R. Damiano, and H. T. Thaler Clinical prediction rule for atrial fibrillation after coronary artery bypass grafting J. Am. Coll. Cardiol., September 15, 2004; 44(6): 1248 - 1253. [Abstract] [Full Text] [PDF]

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				A D Taylor, J G Groen, S L Thorn, C T Lewis, and A J Marshall New insights into onset mechanisms of atrial fibrillation and flutter after coronary artery bypass graft surgery Heart, December 1, 2002; 88(5): 499 - 504. [Abstract] [Full Text] [PDF]

				C. M. White, S. Giri, J. P. Tsikouris, A. Dunn, K. Felton, P. Reddy, and J. Kluger A comparison of two individual amiodarone regimens to placebo in open heart surgery patients Ann. Thorac. Surg., July 1, 2002; 74(1): 69 - 74. [Abstract] [Full Text] [PDF]

				M. Hravnak, L. A. Hoffman, M. I. Saul, T. G. Zullo, and G. R. Whitman Resource Utilization Related to Atrial Fibrillation After Coronary Artery Bypass Grafting Am. J. Crit. Care., May 1, 2002; 11(3): 228 - 238. [Abstract] [Full Text] [PDF]

				W. H. Maisel, J. D. Rawn, and W. G. Stevenson Atrial Fibrillation after Cardiac Surgery Ann Intern Med, December 18, 2001; 135(12): 1061 - 1073. [Abstract] [Full Text] [PDF]

				Guidelines for the management of patients with atrial fibrillation. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines and Policy Conferences (Committee to develop guidelines for the management of patients with atrial fibrillation) developed in collaboration with the North American Society of Pacing and Electrophysiology Eur. Heart J., October 2, 2001; 22(20): 1852 - 1923. [PDF]

ARTICLES

Atrial fibrillation after coronary artery bypass grafting. Is it a disorder of the elderly?

				V. Fuster, L. E. Ryden, R. W. Asinger, D. S. Cannom, H. J. Crijns, R. L. Frye, J. L. Halperin, G. N. Kay, W. W. Klein, S. Levy, et al. ACC/AHA/ESC guidelines for the management of patients with atrial fibrillation: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines and Policy Conferences (Committee to Develop Guidelines for the Management of Patients With Atrial Fibrillation) Developed in Collaboration With the North American Society of Pacing and Electrophysiology J. Am. Coll. Cardiol., October 1, 2001; 38(4): 1266 - 1266. [Full Text] [PDF]

				S. Al-Shanafey, L. Dodds, D. Langille, I. Ali, H. Henteleff, and R. Dobson Nodal vessels disease as a risk factor for atrial fibrillation after coronary artery bypass graft surgery Eur. J. Cardiothorac. Surg., June 1, 2001; 19(6): 821 - 826. [Abstract] [Full Text] [PDF]

				E. N. Deliargyris, G. J. Dehmer, R. A. Archbold, N. P. Curzen, P. G. Mills, A. G. Zaman, G. Helft, and E. A. Paul History Repeats Itself Response Circulation, February 27, 2001; 103 (8): e48 - e48. [Full Text] [PDF]

				M. M. Treggiari-Venzi, J.-L. Waeber, T. V. Perneger, P. M. Suter, R. Adamec, and J.-A. Romand Intravenous amiodarone or magnesium sulphate is not cost-beneficial prophylaxis for atrial fibrillation after coronary artery bypass surgery Br. J. Anaesth., November 1, 2000; 85(5): 690 - 695. [Abstract] [Full Text] [PDF]

				R. Ascione, M. Caputo, G. Calori, C. T. Lloyd, M. J. Underwood, and G. D. Angelini Predictors of Atrial Fibrillation After Conventional and Beating Heart Coronary Surgery : A Prospective, Randomized Study Circulation, September 26, 2000; 102(13): 1530 - 1535. [Abstract] [Full Text] [PDF]

				E. G. Daoud, R. Dabir, M. Archambeau, F. Morady, and S. A. Strickberger Randomized, Double-Blind Trial of Simultaneous Right and Left Atrial Epicardial Pacing for Prevention of Post-Open Heart Surgery Atrial Fibrillation Circulation, August 15, 2000; 102(7): 761 - 765. [Abstract] [Full Text] [PDF]

				P. Evrard, M. Gonzalez, J. Jamart, B. Malhomme, D. Blommaert, P. Eucher, and E. Installe Prophylaxis of supraventricular and ventricular arrhythmias after coronary artery bypass grafting with low-dose sotalol Ann. Thorac. Surg., July 1, 2000; 70(1): 151 - 156. [Abstract] [Full Text] [PDF]

				S.-H. Lee, C.-M. Chang, M.-J. Lu, R.-J. Lee, J.-J. Cheng, C.-R. Hung, and S.-A. Chen Intravenous amiodarone for prevention of atrial fibrillation after coronary artery bypass grafting Ann. Thorac. Surg., July 1, 2000; 70(1): 157 - 161. [Abstract] [Full Text] [PDF]

				D. Blommaert, M. Gonzalez, J. Mucumbitsi, O. Gurne, P. Evrard, M. Buche, Y. Louagie, P. Eucher, J. Jamart, E. Installe, et al. Effective prevention of atrial fibrillation by continuous atrial overdrive pacing after coronary artery bypass surgery J. Am. Coll. Cardiol., May 1, 2000; 35(6): 1411 - 1415. [Abstract] [Full Text] [PDF]

				A. G. Zaman, R. A. Archbold, G. Helft, E. A. Paul, N. P. Curzen, and P. G. Mills Atrial Fibrillation After Coronary Artery Bypass Surgery : A Model for Preoperative Risk Stratification Circulation, March 28, 2000; 101(12): 1403 - 1408. [Abstract] [Full Text] [PDF]