Fluid Balance and Risk of Postoperative Atrial Fibrillation after On-pump Coronary Artery Bypass Grafting Surgery
DOI:
https://doi.org/10.59958/hsf.7661Keywords:
fluid balance, postoperative atrial fibrillation, coronary artery bypass grafting, blood transfusion, risk factorAbstract
Background: Postoperative atrial fibrillation (POAF) is a common complication after coronary artery bypass grafting (CABG) and is associated with increased adverse outcomes. However, the relationship of fluid balance and POAF is not clear yet. Accordingly, this study aims to study the relationship of fluid balance and POAF, and to evaluate the other risk factors of POAF in patients undergoing elective on-pump CABG with or without valve surgery in our center. Methods: A retrospective study between October 2018 and December 2022 including 261 patients who underwent CABG undergoing cardiopulmonary bypass was performed. The fluid balance on the first 4 days in the intensive care unit (ICU) and other potential perioperative risk factors for POAF were collected and analyzed using univariate and multivariate analyses to identify risk factors following CABG. The in-hospital adverse outcomes of POAF were also evaluated. Results: 261 adult CABG patients were evaluated, of whom 22 were excluded due to a history of atrial fibrillation or other causes. Among them, 72 patients developed POAF (30.1%). The mean fluid balance was negative on the first 3 days. Negative fluid balance was less on postoperative day 0 (POD 0) in those developing POAF than in those not developing POAF (–12.88 ± 12.47 vs. –17.48 ± 10.03 mL/kg, p = 0.003). No differences were noted for POD 1 and POD 2. Multiple logistic regression analysis showed age >60 years (adjusted odds ratio (OR), 3.86 [95% confidence interval (CI): 1.99 to 7.48]), left atrial antero-posterior (AP) dimension >42 mm (adjusted OR, 2.68 [95% CI: 1.45 to 4.93]), total blood transfusions >400 mL (adjusted OR, 1.96 [95% CI: 1.05 to 3.63]), and positive fluid balance on POD 0 (adjusted OR, 2.93 [95% CI: 1.01 to 8.51]) were independent perioperative risk factors for POAF. Conclusions: The incidence of POAF is not significantly reduced even with a fluid restriction strategy after CABG, and positive fluid balance on the day of surgery is a risk factor for POAF, rather than on POD 1 and POD 2. In addition, advanced age, left atrial enlargement, and increased perioperative blood transfusion are all risk factors for POAF.
References
Echahidi N, Pibarot P, O'Hara G, Mathieu P. Mechanisms, prevention, and treatment of atrial fibrillation after cardiac surgery. Journal of the American College of Cardiology. 2008; 51: 793–801.
Benedetto U, Gaudino MF, Dimagli A, Gerry S, Gray A, Lees B, et al. Postoperative Atrial Fibrillation and Long-Term Risk of Stroke After Isolated Coronary Artery Bypass Graft Surgery. Circulation. 2020; 142: 1320–1329.
Attaran S, Shaw M, Bond L, Pullan MD, Fabri BM. Atrial fibrillation postcardiac surgery: a common but a morbid complication. Interactive Cardiovascular and Thoracic Surgery. 2011; 12: 772–777.
Eikelboom R, Sanjanwala R, Le ML, Yamashita MH, Arora RC. Postoperative Atrial Fibrillation After Cardiac Surgery: A Systematic Review and Meta-Analysis. The Annals of Thoracic Surgery. 2021; 111: 544–554.
Zacharias A, Schwann TA, Riordan CJ, Durham SJ, Shah AS, Habib RH. Obesity and risk of new-onset atrial fibrillation after cardiac surgery. Circulation. 2005; 112: 3247–3255.
Rezaei Y, Peighambari MM, Naghshbandi S, Samiei N, Ghavidel AA, Dehghani MR, et al. Postoperative Atrial Fibrillation Following Cardiac Surgery: From Pathogenesis to Potential Therapies. American Journal of Cardiovascular Drugs: Drugs, Devices, and other Interventions. 2020; 20: 19–49.
Kalus JS, Caron MF, White CM, Mather JF, Gallagher R, Boden WE, et al. Impact of fluid balance on incidence of atrial fibrillation after cardiothoracic surgery. The American Journal of Cardiology. 2004; 94: 1423–1425.
Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B, et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology: Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology. 2016; 18: 1609–1678.
Koletsis EN, Prokakis C, Crockett JR, Dedeilias P, Panagiotou M, Panagopoulos N, et al. Prognostic factors of atrial fibrillation following elective coronary artery bypass grafting: the impact of quantified intraoperative myocardial ischemia. Journal of Cardiothoracic Surgery. 2011; 6: 127.
Todorov H, Janssen I, Honndorf S, Bause D, Gottschalk A, Baasner S, et al. Clinical significance and risk factors for new onset and recurring atrial fibrillation following cardiac surgery - a retrospective data analysis. BMC Anesthesiology. 2017; 17: 163.
Hravnak M, Hoffman LA, Saul MI, Zullo TG, Whitman GR, Griffith BP. Predictors and impact of atrial fibrillation after isolated coronary artery bypass grafting. Critical Care Medicine. 2002; 30: 330–337.
Shen J, Lall S, Zheng V, Buckley P, Damiano RJ, Jr, Schuessler RB. The persistent problem of new-onset postoperative atrial fibrillation: a single-institution experience over two decades. The Journal of Thoracic and Cardiovascular Surgery. 2011; 141: 559–570.
Mathew JP, Fontes ML, Tudor IC, Ramsay J, Duke P, Mazer CD, et al. A multicenter risk index for atrial fibrillation after cardiac surgery. JAMA. 2004; 291: 1720–1729.
Lin YK, Chen YA, Lee TI, Chen YC, Chen SA, Chen YJ. Aging Modulates the Substrate and Triggers Remodeling in Atrial Fibrillation. Circulation Journal: Official Journal of the Japanese Circulation Society. 2018; 82: 1237–1244.
Benjamin EJ, Levy D, Vaziri SM, D'Agostino RB, Belanger AJ, Wolf PA. Independent risk factors for atrial fibrillation in a population-based cohort. The Framingham Heart Study. JAMA. 1994; 271: 840–844.
Hakala T, Hedman A, Turpeinen A, Kettunen R, Vuolteenaho O, Hippeläinen M. Prediction of atrial fibrillation after coronary artery bypass grafting by measuring atrial peptide levels and preoperative atrial dimensions. European Journal of Cardio-thoracic Surgery: Official Journal of the European Association for Cardio-thoracic Surgery. 2002; 22: 939–943.
Ducceschi V, D'Andrea A, Liccardo B, Alfieri A, Sarubbi B, De Feo M, et al. Perioperative clinical predictors of atrial fibrillation occurrence following coronary artery surgery. European Journal of Cardio-thoracic Surgery: Official Journal of the European Association for Cardio-thoracic Surgery. 1999; 16: 435–439.
Greenberg JW, Lancaster TS, Schuessler RB, Melby SJ. Postoperative atrial fibrillation following cardiac surgery: a persistent complication. European Journal of Cardio-thoracic Surgery: Official Journal of the European Association for Cardio-thoracic Surgery. 2017; 52: 665–672.
Osranek M, Fatema K, Qaddoura F, Al-Saileek A, Barnes ME, Bailey KR, et al. Left atrial volume predicts the risk of atrial fibrillation after cardiac surgery: a prospective study. Journal of the American College of Cardiology. 2006; 48: 779–786.
Ismail MF, El-Mahrouk AF, Hamouda TH, Radwan H, Haneef A, Jamjoom AA. Factors influencing postoperative atrial fibrillation in patients undergoing on-pump coronary artery bypass grafting, single center experience. Journal of Cardiothoracic Surgery. 2017; 12: 40.
Koch CG, Li L, Van Wagoner DR, Duncan AI, Gillinov AM, Blackstone EH. Red cell transfusion is associated with an increased risk for postoperative atrial fibrillation. The Annals of Thoracic Surgery. 2006; 82: 1747–1756.
Alameddine AK, Visintainer P, Alimov VK, Rousou JA. Blood transfusion and the risk of atrial fibrillation after cardiac surgery. Journal of Cardiac Surgery. 2014; 29: 593–599.
Ferraris VA, Ballert EQ, Mahan A. The relationship between intraoperative blood transfusion and postoperative systemic inflammatory response syndrome. American Journal of Surgery. 2013; 205: 457–465.
Rezaei Y. Anti-Inflammatory Role of Statins in Preventing Postoperative Atrial Fibrillation. The American Journal of Cardiology. 2016; 117: 314.
Tselentakis EV, Woodford E, Chandy J, Gaudette GR, Saltman AE. Inflammation effects on the electrical properties of atrial tissue and inducibility of postoperative atrial fibrillation. The Journal of Surgical Research. 2006; 135: 68–75.
Abdelhadi RH, Gurm HS, Van Wagoner DR, Chung MK. Relation of an exaggerated rise in white blood cells after coronary bypass or cardiac valve surgery to development of atrial fibrillation postoperatively. The American Journal of Cardiology. 2004; 93: 1176–1178.
Lamm G, Auer J, Weber T, Berent R, Ng C, Eber B. Postoperative white blood cell count predicts atrial fibrillation after cardiac surgery. Journal of Cardiothoracic and Vascular Anesthesia. 2006; 20: 51–56.
Fontes ML, Amar D, Kulak A, Koval K, Zhang H, Shi W, et al. Increased preoperative white blood cell count predicts postoperative atrial fibrillation after coronary artery bypass surgery. Journal of Cardiothoracic and Vascular Anesthesia. 2009; 23: 484–487.
Lo B, Fijnheer R, Nierich AP, Bruins P, Kalkman CJ. C-reactive protein is a risk indicator for atrial fibrillation after myocardial revascularization. The Annals of Thoracic Surgery. 2005; 79: 1530–1535.
Patti G, Chello M, Candura D, Pasceri V, D'Ambrosio A, Covino E, et al. Randomized trial of atorvastatin for reduction of postoperative atrial fibrillation in patients undergoing cardiac surgery: results of the ARMYDA-3 (Atorvastatin for Reduction of MYocardial Dysrhythmia After cardiac surgery) study. Circulation. 2006; 114: 1455–1461.
