Atrial Fibrillation Predicts Worse Long Time Prognosis after CABG – A 6-Year Survival Analysis

Lars P. Riber

Department of Cardiothoracic and Vascular Surgery & Institute of Clinical Medicine, Aarhus University Hospital, Aarhus N, Denmark.

DOI: 10.4236/ojts.2012.22006                

Abstract

Background: Postoperative atrial fibrillation occurs in 5% - 65% of patients undergoing cardiac surgery. Although postoperative atrial fibrillation is often regarded as a temporary, benign, operation-related problem, it is associated with a two- to threefold increased risk of adverse events, including permanent or transient stroke, acute myocardial infarction, and death. Methods: Two hundred and fifty eligible consecutively enrolled coronary artery bypass grafting patients were included in the randomized, controlled, double-blinded trial RASCABG. That study showed a safe, practical, feasible, and effective prophylactic amiodarone regimen, which significantly decreased the risk of atrial fibrillation with 14% (5.0 - 24) from 26% to 11%, with the number needed to treat 6.9 (4.2 - 20). This study is a 6-year follow-up study regarding the long-term prognostic factor of postoperative atrial fibrillation, amiodarone prophylaxis and diabetes mellitus. Results: The long-term 6-year mortality risk of postoperative atrial fibrillation was 31% equally distributed among patients in the active and in the placebo prophylactic group. The 6-year mortality risk in the sinus rhythm group was 18% likewise equally distributed, whereas the 6-year mortality risk in the background population was approximately 8%. The 6-year mortality risk of diabetes mellitus was 33% equally distributed, whereas the excluded off pump coronary artery bypass group experiences an increased 6-year mortality risk of 47%. Conclusions: Postoperative prophylaxis with a high dose of oral amiodarone after an intravenous bolus infusion is a safe, practical, feasible, and effective regimen for Coronary Artery Bypass Grafting patients in a 6-year long-term perspective. Atrial fibrillation and diabetes mellitus is correlated to increased mortality risk.

Keywords

Atrial Fibrillation; CABG; Pharmacology; Postoperative Care

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	S. R. Ommen, J. A. Odell and M. S. Stanton,“Atrial Arrhythmias after Cardiothoracic Surgery," The New England Journal of Medicine, Vol. 336, No. 20, 1997, pp. 1429-1434. doi:10.1056/NEJM199705153362006
[2]	W. H. Maisel, J. D. Rawn and W. G. Stevenson, “Atrial Fibrillation after Cardiac Surgery," Annals of Internal Medicine, Vol. 135, No. 12, 2001, pp. 1061-1073.
[3]	L. R. Zebis, T. D. Christensen, H. F. Thomsen, M. M. Mikkelsen, L. Folkersen, H. T. S?rensen and V. E. Hjortdal, "A Practical Regimen for Amiodarone Use in Preventing Postoperative Atrial Fibrillation," The Annals of Thoracic Surgery, Vol. 83, No. 4, 2007, pp. 1326-1331. doi:10.1016/j.athoracsur.2006.09.096
[4]	M. E. Halkos, T. A. Vassiliades, J. S. Douglas, D. C. Morris, T. Rab, H. A. Liberman, H. Samady, P. D. Kilgo, R. A. Guyton and J. D. Puskas, “Hybrid Coronary Revascularization versus Off-Pump Coronary Artery Bypass Grafting for the Treatment of Multivessel Coronary Artery Disease," The Annals of Thoracic Surgery, Vol. 92, No. 5, 2011, pp. 1695-1702. doi:10.1016/j.athoracsur.2011.05.090