Diastolic dysfunction, cardiopulmonary bypass, and atrial fibrillation after coronary artery bypass graft surgery

C M Ashes; M Yu; M Meineri; R Katznelson; J Carroll; V Rao; G Djaiani

doi:10.1093/bja/aeu208

Diastolic dysfunction, cardiopulmonary bypass, and atrial fibrillation after coronary artery bypass graft surgery

Br J Anaesth. 2014 Nov;113(5):815-21. doi: 10.1093/bja/aeu208. Epub 2014 Jul 8.

Authors

C M Ashes¹, M Yu², M Meineri², R Katznelson², J Carroll², V Rao³, G Djaiani⁴

Affiliations

¹ Department of Anesthesia and Pain Management, EN 3-410, Toronto General Hospital, University Health Network, University of Toronto, 200 Elizabeth Street, Toronto, ON, Canada M5G 2C4 Present address: Department of Anaesthesia, c/o St Vincent's Hospital,390 Victoria Street, Darlinghurst, NSW 2010, Australia.
² Department of Anesthesia and Pain Management, EN 3-410, Toronto General Hospital, University Health Network, University of Toronto, 200 Elizabeth Street, Toronto, ON, Canada M5G 2C4.
³ Division of Cardiovascular Surgery, University Health Network, University of Toronto, Toronto, ON, Canada M5G2C4.
⁴ Department of Anesthesia and Pain Management, EN 3-410, Toronto General Hospital, University Health Network, University of Toronto, 200 Elizabeth Street, Toronto, ON, Canada M5G 2C4 [email protected].

PMID: 25005721
DOI: 10.1093/bja/aeu208

Abstract

Background: Atrial fibrillation (AF) is a common complication after coronary artery bypass graft (CABG) surgery, and is associated with increased morbidity, mortality, and utilization of healthcare resources. Diastolic dysfunction (DD) causes a range of changes in left atrial structure and function that may predispose patients to increased risk of AF. We hypothesized that patients with either new or worsened grade of DD after cardiopulmonary bypass (CPB) would have higher prevalence of AF after CABG surgery. The current study sought to determine an association between the dynamic changes in diastolic function during the perioperative period and postoperative AF in patients undergoing CABG surgery.

Methods: A total of 109 patients undergoing elective CABG surgery were assessed for the presence of DD before and after CPB. All patients were monitored for the development of AF after surgery for the entire hospital stay.

Results: DD was present in 89 (81%) and 91 (83%) patients before and after CPB. Thirty-four (31%) patients had either new or worsened grade of DD after CPB. Postoperative AF was present in 30 (27.5%) patients, including 15 (44%) patients with either new or worsened DD, and 15 (20%) patients with either unchanged or improved DD (P=0.009). Independent predictors of postoperative AF included age ≥65 yr [odds ratio (OR) 4.207, 95% confidence interval (CI) 1.527, 11.588], and new or worsened DD (OR 4.145, 95% CI 1.519, 11.356).

Conclusions: New or worsened DD after CABG surgery is associated with an increased incidence of postoperative AF.

Clinical trial registration: http://www.clinicaltrials.gov; unique identifier NCT00188903.

Keywords: atrial fibrillation; coronary artery bypass; echocardiography, transoesophageal; heart failure, diastolic.

Publication types

Clinical Trial
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Aged
Aged, 80 and over
Anesthesia
Atrial Fibrillation / diagnostic imaging
Atrial Fibrillation / etiology*
Cardiopulmonary Bypass / adverse effects*
Coronary Artery Bypass / adverse effects*
Female
Heart Failure, Diastolic / diagnostic imaging
Heart Failure, Diastolic / etiology*
Heart Function Tests
Humans
Male
Middle Aged
Postoperative Complications / diagnostic imaging
Postoperative Complications / etiology*
Ultrasonography

Associated data

ClinicalTrials.gov/NCT00188903