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Ann Thorac Surg 1993;56:539-549
© 1993 The Society of Thoracic Surgeons
Division of Cardiothoracic Surgery, Department of Surgery, Barnes Hospital, Washington University School of Mediane, St. Louis, Missouri USA
Accepted for publication January 26, 1993.
* Address reprint requests to Dr Rosenbloom, Division of Cardiothoracic Surgery, 3105 Queeny Tower, Barnes Hospital, One Barnes Hospital Plaza, St. Louis, MO 63110.
Between January 1, 1986, and December 31, 1991, 4,507 adult patients underwent cardiac surgical procedures requiring cardiopulmonary bypass. Of these patients, 3,983 patients who did not undergo operation for supraventricular tachycardia and who were in normal sinus rhythm preoperatively form the study group for the present study. Postoperatively, all patients were monitored continuously for the development of arrhythmias until the time of hospital discharge. The incidence of atrial arrhythmias requiring treatment for the most commonly performed operative procedures were as follows: coronary artery bypass grafting, 31.9%; coronary artery bypass grafting and mitral valve replacement, 63.6%; coronary artery bypass grafting and aortic valve replacement, 48.8%; and heart transplantation, 11.1%. For all patients considered collectively, the risk factors associated with an increased incidence of postoperative atrial arrhythmias (p < 0.05 by multivariate logistic regression) included increasing patient age, ptcoperative use of digoxin, history of rheumatic heart disease, chronic obstructive pulmonary disease, and increasing aortic crossclamp time. Postoperative atrial fibrillation was associated with an increased incidence of postoperative stroke (3.3% versus 1.4%; p < 0.0005), increased length of hospitalization in the intensive care unit (5.7 versus 3.4 days; p = 0.0001) and postoperative nursing ward (10.9 versus 7.5 days; p = 0.0001), increased incidence of postoperative ventricular tachycardia or fibrillation (9.2% versus 4.0%; p < 0.0005), and an increased need for placement of a permanent pacemaker (3.7% versus 1.6%; p < 0.0005). These data provide a basis for targeting specific patient subgroups for prospective, randomized trials of therapeutic modalities designed to decrease the incidence of postoperative atrial arrhythmias.
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L. B. Mitchell, D. V. Exner, D. G. Wyse, C. J. Connolly, G. D. Prystai, A. J. Bayes, W. T. Kidd, T. Kieser, J. J. Burgess, A. Ferland, et al. Prophylactic Oral Amiodarone for the Prevention of Arrhythmias That Begin Early After Revascularization, Valve Replacement, or Repair: PAPABEAR: A Randomized Controlled Trial JAMA, December 28, 2005; 294(24): 3093 - 3100. [Abstract] [Full Text] [PDF]
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L. L. Creswell, J. C. Alexander Jr., T. B. Ferguson Jr., A. Lisbon, and L. A. Fleisher Intraoperative Interventions: American College of Chest Physicians Guidelines for the Prevention and Management of Postoperative Atrial Fibrillation After Cardiac Surgery Chest, August 1, 2005; 128(2_suppl): 28S - 35S. [Abstract] [Full Text] [PDF]
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E. A. Martinez, E. B. Bass, and P. Zimetbaum Pharmacologic Control of Rhythm: American College of Chest Physicians Guidelines for the Prevention and Management of Postoperative Atrial Fibrillation After Cardiac Surgery Chest, August 1, 2005; 128(2_suppl): 48S - 55S. [Abstract] [Full Text] [PDF]
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E. A. Martinez, A. E. Epstein, and E. B. Bass Pharmacologic Control of Ventricular Rate: American College of Chest Physicians Guidelines for the Prevention and Management of Postoperative Atrial Fibrillation After Cardiac Surgery Chest, August 1, 2005; 128(2_suppl): 56S - 60S. [Abstract] [Full Text] [PDF]
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K. Prasongsukarn, J. G. Abel, W.R. E. Jamieson, A. Cheung, J. A. Russell, K. R. Walley, and S. V. Lichtenstein The effects of steroids on the occurrence of postoperative atrial fibrillation after coronary artery bypass grafting surgery: A prospective randomized trial J. Thorac. Cardiovasc. Surg., July 1, 2005; 130(1): 93 - 98. [Abstract] [Full Text] [PDF]
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 E. L. Gillespie, K. A. Gryskiewicz, C. M. White, J. Kluger, C. Humphrey, S. Horowitz, and C. I. Coleman Effect of aprotinin on the frequency of postoperative atrial fibrillation or flutter Am. J. Health Syst. Pharm., July 1, 2005; 62(13): 1370 - 1374. [Abstract] [Full Text] [PDF]
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Y. Ishii, R. B. Schuessler, S. L. Gaynor, K. Yamada, A. S. Fu, J. P. Boineau, and R. J. Damiano Jr Inflammation of Atrium After Cardiac Surgery Is Associated With Inhomogeneity of Atrial Conduction and Atrial Fibrillation Circulation, June 7, 2005; 111(22): 2881 - 2888. [Abstract] [Full Text] [PDF]
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K. Ak, S. Akgun, T. Tecimer, C. S. Isbir, A. Civelek, A. Tekeli, S. Arsan, and A. Cobanoglu Determination of Histopathologic Risk Factors for Postoperative Atrial Fibrillation in Cardiac Surgery Ann. Thorac. Surg., June 1, 2005; 79(6): 1970 - 1975. [Abstract] [Full Text] [PDF]
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S Miller, E Crystal, M Garfinkle, C Lau, I Lashevsky, and S J Connolly Effects of magnesium on atrial fibrillation after cardiac surgery: a meta-analysis Heart, May 1, 2005; 91(5): 618 - 623. [Abstract] [Full Text] [PDF]
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R. Kailasam, C. A. Palin, and C. W. Hogue Jr Atrial Fibrillation After Cardiac Surgery: An Evidence-Based Approach to Prevention Seminars in Cardiothoracic and Vascular Anesthesia, March 1, 2005; 9(1): 77 - 85. [Abstract] [PDF]
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G. Djaiani, L. Fedorko, and W. S. Beattie Regional Anesthesia in Cardiac Surgery: A Friend or A Foe? Seminars in Cardiothoracic and Vascular Anesthesia, March 1, 2005; 9(1): 87 - 104. [Abstract] [PDF]
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N. Hayashida, T. Shojima, Y. Yokokura, H. Hori, K. Yoshikawa, H. Tomoeda, and S. Aoyagi P-Wave Signal-Averaged Electrocardiogram for Predicting Atrial Arrhythmia After Cardiac Surgery Ann. Thorac. Surg., March 1, 2005; 79(3): 859 - 864. [Abstract] [Full Text] [PDF]
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K. Mandal, E. Torsney, J. Poloniecki, A. J. Camm, Q. Xu, and M. Jahangiri Association of High Intracellular, But Not Serum, Heat Shock Protein 70 With Postoperative Atrial Fibrillation Ann. Thorac. Surg., March 1, 2005; 79(3): 865 - 871. [Abstract] [Full Text] [PDF]
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J. Alex and L. Guvendik Evaluation of Ventral Cardiac Denervation As a Prophylaxis Against Atrial Fibrillation After Coronary Artery Bypass Grafting Ann. Thorac. Surg., February 1, 2005; 79(2): 517 - 520. [Abstract] [Full Text] [PDF]
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R. J. DiDomenico and M. G. Massad Pharmacologic Strategies for Prevention of Atrial Fibrillation After Open Heart Surgery Ann. Thorac. Surg., February 1, 2005; 79(2): 728 - 740. [Abstract] [Full Text] [PDF]
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U. Izhar, N. Ad, E. Rudis, E. Milgalter, A. Korach, N. Viola, E. Levi, G. Asraff, G. Merin, and A. Elami When should we discontinue antiarrhythmic therapy for atrial fibrillation after coronary artery bypass grafting? A prospective randomized study J. Thorac. Cardiovasc. Surg., February 1, 2005; 129(2): 401 - 406. [Abstract] [Full Text] [PDF]
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N. Ad, A. Schneider, I. Khaliulin, J. B. Borman, and H. Schwalb Impaired mitochondrial response to simulated ischemic injury as a predictor of the development of atrial fibrillation after cardiac surgery: In vitro study in human myocardium J. Thorac. Cardiovasc. Surg., January 1, 2005; 129(1): 41 - 45. [Abstract] [Full Text] [PDF]
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T. Hakala, A. J.M. Valtola, A. K. Turpeinen, A. E. Hedman, R. E.U. Vuorenniemi, J. M. Karjalainen, I. S. Vajanto, J. Kouri, P. A. Jaakkola, and J. E.K. Hartikainen Right atrial overdrive pacing does not prevent atrial fibrillation after coronary artery bypass surgery Europace, January 1, 2005; 7(2): 170 - 174. [Abstract] [Full Text] [PDF]
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B. J. Drew, R. M. Califf, M. Funk, E. S. Kaufman, M. W. Krucoff, M. M. Laks, P. W. Macfarlane, C. Sommargren, S. Swiryn, and G. F. Van Hare Practice Standards for Electrocardiographic Monitoring in Hospital Settings: An American Heart Association Scientific Statement From the Councils on Cardiovascular Nursing, Clinical Cardiology, and Cardiovascular Disease in the Young: Endorsed by the International Society of Computerized Electrocardiology and the American Association of Critical-Care Nurses Circulation, October 26, 2004; 110(17): 2721 - 2746. [Abstract] [Full Text] [PDF]
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S. J. Kernis, V. T. Nkomo, D. Messika-Zeitoun, B. J. Gersh, T. M. Sundt III, K. V. Ballman, C. G. Scott, H. V. Schaff, and M. Enriquez-Sarano Atrial Fibrillation After Surgical Correction of Mitral Regurgitation in Sinus Rhythm: Incidence, Outcome, and Determinants Circulation, October 19, 2004; 110(16): 2320 - 2325. [Abstract] [Full Text] [PDF]
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J. M. Leung, W. H. Bellows, and N. B. Schiller Impairment of left atrial function predicts post-operative atrial fibrillation after coronary artery bypass graft surgery Eur. Heart J., October 2, 2004; 25(20): 1836 - 1844. [Abstract] [Full Text] [PDF]
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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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Y. Ishii, M. J. Gleva, M. C. Gamache, R. B. Schuessler, J. P. Boineau, M. S. Bailey, and R. J. Damiano Jr Atrial Tachyarrhythmias After the Maze Procedure: Incidence and Prognosis Circulation, September 14, 2004; 110(11_suppl_1): II-164 - II-168. [Abstract] [Full Text] [PDF]
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C. A. Palin, R. Kailasam, and C. W. Hogue Jr Atrial Fibrillation After Cardiac Surgery: Pathophysiology and Treatment Seminars in Cardiothoracic and Vascular Anesthesia, September 1, 2004; 8(3): 175 - 183. [Abstract] [PDF]
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 J. Dunning, D. V. Nagarajan, M. Amanullah, and S. M. Nouraei What is the optimal anticoagulation management of patients post-cardiac surgery who go into atrial fibrillation? Interact CardioVasc Thorac Surg, September 1, 2004; 3(3): 503 - 509. [Abstract] [Full Text] [PDF]
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D. E. Singer, G. W. Albers, J. E. Dalen, A. S. Go, J. L. Halperin, and W. J. Manning Antithrombotic Therapy in Atrial Fibrillation: The Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy Chest, September 1, 2004; 126(3_suppl): 429S - 456S. [Abstract] [Full Text] [PDF]
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D. Zimpfer, M. Czerny, F. Vogt, P. Schuch, L. Kramer, E. Wolner, and M. Grimm Neurocognitive deficit following coronary artery bypass grafting: a prospective study of surgical patients and nonsurgical controls Ann. Thorac. Surg., August 1, 2004; 78(2): 513 - 518. [Abstract] [Full Text] [PDF]
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T. D. Nielsen, T. Bahnson, R. D. Davis, and S. M. Palmer Atrial Fibrillation After Pulmonary Transplant Chest, August 1, 2004; 126(2): 496 - 500. [Abstract] [Full Text] [PDF]
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O. M. Wazni, D. O. Martin, N. F. Marrouche, A. A. Latif, K. Ziada, M. Shaaraoui, S. Almahameed, R. A. Schweikert, W. I. Saliba, A. M. Gillinov, et al. Plasma B-Type Natriuretic Peptide Levels Predict Postoperative Atrial Fibrillation in Patients Undergoing Cardiac Surgery Circulation, July 13, 2004; 110(2): 124 - 127. [Abstract] [Full Text] [PDF]
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J. A. Yeung-Lai-Wah, A. Qi, E. McNeill, J. G. Abel, S. Tung, K. H. Humphries, and C. R. Kerr New-onset sustained ventricular tachycardia and fibrillation early after cardiac operations Ann. Thorac. Surg., June 1, 2004; 77(6): 2083 - 2088. [Abstract] [Full Text] [PDF]
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J. Lahtinen, F. Biancari, E. Salmela, M. Mosorin, J. Satta, P. Rainio, J. Rimpilainen, M. Lepojarvi, and T. Juvonen Postoperative atrial fibrillation is a major cause of stroke after on-pump coronary artery bypass surgery Ann. Thorac. Surg., April 1, 2004; 77(4): 1241 - 1244. [Abstract] [Full Text] [PDF]
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