Heart Rhythm Disturbances in Cardiac Surgery Patients with Coronary Artery Disease

DOI: https://doi.org/10.30702/ujcvs/24.32(03)/G051-1722
Keywords: surgical myocardial revascularization, artificial blood circulation, chronic coronary syndrome, atrial fibrillation, comorbidity, type 2 diabetes, amiodarone, anticoagulants

Abstract

The aim. To analyze arrhythmological complications in cardiac surgery patients with coronary artery disease (CAD).

Materials and methods. This was a retrospective data analysis of 354 cardiac surgery patients with various forms of CAD who were operated on and discharged from the National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine. The mean age of the patients was 61.9 ± 9.6 years. All the patients underwent laboratory examinations, electrocardiography, echocardiography, coronary angiography and cardiac surgery. The patients with uncomplicated forms of CAD (n = 194) underwent isolated surgical revascularization of the myocardium, in the case of complicated forms of CAD (n = 160), coronary bypass surgery was supplemented with valvular or ventricular correction.

Results. Postoperative atrial fibrillation (AF) occurred in 40 (20.6%) patients with uncomplicated CAD and 43 patients with complicated CAD (26.8%), p = 0.1667. Among patients with complicated forms of CAD, 2 (1.25%) had paroxysms of ventricular tachycardia, which required the implantation of a cardioverter-defibrillator, also in this group of patients complete left bundle branch block occurred more often (p = 0.0020). The postoperative period in patients with impaired glucose metabolism was characterized by more frequent development of AF in patients with type 2 diabetes mellitus (33.3%, p = 0.0006), with impaired glucose tolerance (24.8%, p = 0.0156) compared to patients with normoglycemia (12.6%).

Conclusions. There was no statistically significant difference in the frequency of postoperative AF in patients with various forms of CAD (p = 0.1667). In the occurrence of postoperative AF paroxysms, the negative influence of type 2 diabetes mellitus (p = 0.0006), impaired glucose tolerance (p = 0.0156), stage III-IV chronic kidney disease (p = 0.0015) and gouty arthritis (p = 0.0072) has been proven. The presence of postoperative AF was associated with acute encephalopathy (p = 0.0291) and panic attacks (p = 0.0043). The occurrence of postoperative AF increased the length of stay of cardiac surgery patients with CAD in the hospital from 8.2 ± 2.9 to 11.06 ± 6.8 days (p < 0.0001).

References

  1. Neumann FJ, Sousa-Uva M, Ahlsson A, Alfonso F, Banning AP, Benedetto U, et al.; ESC Scientific Document Group. 2018 ESC/EACTS Guidelines on myocardial revascularization. Eur Heart J. 2019;40(2):87-165. https://doi.org/10.1093/eurheartj/ehy394
  2. Tzoumas A, Nagraj S, Tasoudis P, Arfaras-Melainis A, Palaiodimos L, Kokkinidis DG, et al. Atrial Fibrillation Following Coronary Artery Bypass Graft: Where Do We Stand? Cardiovasc Revasc Med. 2022;40:172-179. https://doi.org/10.1016/j.carrev.2021.12.006
  3. Arsenault KA, Yusuf AM, Crystal E, Healey JS, Morillo CA, Nair GM, et al. Interventions for preventing post-operative atrial fibrillation in patients undergoing heart surgery. Cochrane Database Syst Rev. 2013;2013(1):CD003611. https://doi.org/10.1002/14651858.CD003611.pub3
  4. 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. J Thorac Cardiovasc Surg. 2011;141(2):559-570. https://doi.org/10.1016/j.jtcvs.2010.03.011
  5. LaPar DJ, Speir AM, Crosby IK, Fonner E Jr, Brown M, Rich JB, et al.; Investigators for the Virginia Cardiac Surgery Quality Initiative. Postoperative Atrial Fibrillation Significantly Increases Mortality, Hospital Readmission, and Hospital Costs. Ann Thorac Surg. 2014;98(2):527-533. https://doi.org/10.1016/j.athoracsur.2014.03.039
  6. Gialdini G, Nearing K, Bhave PD, Bonuccelli U, Iadecola C, Healey JS, et al. Perioperative Atrial Fibrillation and the Long-term Risk of Ischemic Stroke. JAMA. 2014;312(6):616-622. https://doi.org/10.1001/jama.2014.9143
  7. Kadric N, Osmanovic E. Rhythm Disturbance After Myocardial Revascularization. Med Arch. 2017;71(6):400-403. https://doi.org/10.5455/medarh.2017.71.400-403
  8. Omar A, Ehab M Elshihy, Mahmoud Singer, David Zarif, Omar Dawoud. Perioperative Risk Factors Predisposing to Atrial Fibrillation After CABG Surgery. Heart Surg Forum. 2021;24(2):E402-E406. https://doi.org/10.1532/hsf.3759
  9. Yaghoobian R, Hosseini Dolama R, Soleimani H, Saeidi S, Mashayekhi M, Mirzayi P, et al. Incidence of atrioventricular block after isolated coronary artery bypass grafting: a systematic review and pooled-analysis. Front Cardiovasc Med. 2023;10:1225833. https://doi.org/10.3389/fcvm.2023.1225833
  10. Clay-Weinfeld K, Callans M. Common Postcardiothoracic Surgery Arrhythmias. Crit Care Nurs Clin North Am. 2019;31(3):367-388. https://doi.org/10.1016/j.cnc.2019.05.006
  11. Assaf A, Diletti R, Hoogendijk MG, van der Graaf M, Zijlstra F, Szili-Torok T, et al. Vulnerability for ventricular arrhythmias in patients with chronic coronary total occlusion. Expert Rev Cardiovasc Ther. 2020;18(8):487-494. https://doi.org/10.1080/14779072.2020.1793671
  12. Assaf A, Sakhi R, Diletti R, Hirsch A, Allaart CP, Bhagwandien R, et al. Incidence of ventricular arrhythmias in patients with chronic total coronary occlusion: Results of the VACTOR study. Int J Cardiol Heart Vasc. 2023;50:101323. https://doi.org/10.1016/j.ijcha.2023.101323
  13. Liao R, Li Z, Wang Q, Lin H, Sun H. Revascularization of chronic total occlusion coronary artery and cardiac regeneration. Front Cardiovasc Med. 2022;9:940808. https://doi.org/10.3389/fcvm.2022.940808
  14. van der Graaf M, Jewbali LSD, Lemkes JS, Spoormans EM, van der Ent M, Meuwissen M, et al. Infarct-related chronic total coronary occlusion and the risk of ventricular tachyarrhythmic events in out-of-hospital cardiac arrest survivors. Neth Heart J. 2021;29(10):500-505. https://doi.org/10.1007/s12471-021-01578-3
  15. ESC Scientific Document Group. Linee guida ESC 2022 per la gestione dei pazienti con aritmie ventricolari e la prevenzione della morte cardiaca improvvisa [2022 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death]. G Ital Cardiol (Rome). 2023;24(3 Suppl 1):e1-e132. Italian. https://doi.org/10.1714/3986.39669
  16. Könemann H, Ellermann C, Zeppenfeld K, Eckardt L. Management of Ventricular Arrhythmias Worldwide: Comparison of the Latest ESC, AHA/ACC/HRS, and CCS/ CHRS Guidelines. JACC Clin Electrophysiol. 2023;9(5):715-728. https://doi.org/10.1016/j.jacep.2022.12.008
  17. Hernandez AV, Kaw R, Pasupuleti V, Bina P, Ioannidis JP, Bueno H, et al.; Cardiovascular Meta-Analyses Research Group. Association Between Obesity and Postoperative Atrial Fibrillation in Patients Undergoing Cardiac Operations: A Systematic Review and Meta-Analysis. Ann Thorac Surg. 2013;96(3):1104-1116. https://doi.org/10.1016/j.athoracsur.2013.04.029
  18. Gogayeva OK. [Algorithms of Perioperative Management of High-Risk Cardiac Surgery Patients with Coronary Artery Disease and Polymorbidity]. Ukrainian Journal of Cardiovascular Surgery. 2023;31(1):10-18. Ukrainian. https://doi.org/10.30702/ujcvs/23.31(01)/G005-1018
  19. Zhao H, Liu M, Chen Z, Mei K, Yu P, Xie L. Dose-response analysis between hemoglobin A1c and risk of atrial fibrillation in patients with and without known diabetes. PLoS One. 2020;15(2):e0227262. https://doi.org/10.1371/journal.pone.0227262
Published
2024-09-27
How to Cite
Gogayeva, O. K. (2024). Heart Rhythm Disturbances in Cardiac Surgery Patients with Coronary Artery Disease. Ukrainian Journal of Cardiovascular Surgery, 32(3), 17-22. https://doi.org/10.30702/ujcvs/24.32(03)/G051-1722
Issue
Ukrainian Journal of Cardiovascular Surgery Vol 32 No 3 2024
Section
ISCHEMIC HEART DISEASE

Most read articles by the same author(s)

1 2 > >>