The role of atherosclerotic coronary arteries lesions in development of new-onset atrial fibrillation after coronary artery bypass surgery

Aim    To study the relationship between the type of circulation, severity and localization of atherosclerotic damage of coronary arteries, results of laboratory and instrumental tests, and historical data in patients with multivascular coronary lesions and atrial fibrillation (AF) that developed after coronary bypass surgery.
Material and methods    This was a novel, retrospective study of data of patients after elective coronary bypass surgery at the Cardiac Surgery Department #1 of the N.V. Sklifosofsky Research Institute of Emergency Care from December, 2018 through December, 2020. The study included 100 patients. The main group consisted of 20 patients whose early postoperative period (first 7 days after surgery) was complicated with postoperative atrial fibrillation (POAF) (mean age, 65.15±9.7 years). The comparison group included 80 patients without the POAF complication during the early postoperative period (mean age, 62.0±9.16 years). Prior to the coronary bypass surgery, all patients underwent clinical, laboratory, and instrumental examination. Based on data of selective coronary angiography, localization, severity of coronary atherosclerotic damage (according to angiographic classification), number of affected arteries, and the type of circulation were taken into account.
Results    Intergroup differences in the incidence and localization of myocardial infarctions in history, severity of arterial hypertension in history, class of chronic heart failure (according to the New York Heart Association, NYHA, classification), and heart rate were absent. 100 % of patients had left atrial (LA) dilatation not correlated with the development of AF in the early postoperative period. According to data of coronary angiography, there was no statistically significant association between the type of circulation and the development of POAF. The right type of myocardial blood supply prevailed in patients of both groups. There was no correlation between the severity and localization of coronary atherosclerotic lesions and the development of AF in the early postoperative period.
Conclusion    The development of AF following coronary bypass surgery was not associated with features of coronary atherosclerotic lesions, which may indicate active development of inter- and intra-systemic anastomoses in patients with long-term history of chronic coronary atherosclerosis.

1. Lomivorotov V.V., Efremov S.M., Pokushаlov E.А., Boboshko V.А. Atrial fibrillation after cardiac surgery: pathophysiology and methods of prevention. Bulletin of Anesthesiology and Resuscitation. 2017;14(1):58–66. DOI: 10.21292/2078-5658-2017-14-1-58-66

2. Turagam MK, Downey FX, Kress DC, Sra J, Tajik AJ, Jahangir A. Pharmacological strategies for prevention of postoperative atrial fibrillation. Expert Review of Clinical Pharmacology. 2015;8(2):233–50. DOI: 10.1586/17512433.2015.1018182

3. Petrakova E.S., Savina N.M., Molochkov A.V. Atrial fibrillation after coronary artery bypass surgery: risk factors, prevention and treatment. Kardiologiia. 2020;60(9):134–48. DOI: 10.18087/cardio.2020.9.n1074

4. Shenasa M, Soleimanieh M, Shenasa F. Individualized therapy in patients with atrial fibrillation: new look at atrial fibrillation. Europace. 2012;14(Suppl 5):v121–4. DOI: 10.1093/europace/eus280

5. Drapkina O. M., Emelyanov A. V. Fibrosis and atrial fibrillation – mechanisms and treatment. Arterial Hypertension. 2013;19(6):487–94. DOI: 10.18705/1607-419X-2013-19-6-487-494

6. Grigoryan S.V., Azarapetyan L.G., Adamyan K.G. Myocardial fibrosis and atrial fibrillation. Russian Journal of Cardiology. 2018;23(9):71–6. DOI: 10.15829/1560-4071-2018-9-71-76

7. Stukalova O.V., Aparina O.P., Mironova N.A., Golitsyn S.P. Left atrial fibrosis in patients with atrial fibrillation according to magnetic resonance imaging with late gadolinium enhancement. Almanac of Clinical Medicine. 2015;43:29–37. DOI: 10.18786/2072-0505-2015-43-29-37

8. Karetnikova V.N., Kashtalap V.V., Kosareva S.N., Barbarash O.L. Myocardial fibrosis: Current aspects of the problem. Therapeutic Archive. 2017;89(1):88–93. DOI: 10.17116/terarkh201789188-93

9. Tlegenova Zh.Sh., Zholdin B.K., Kudaiberdieva G.Z., Abdrakhmanov A.S. Factors associated with atrial fibrillation in patients with hypertension and preserved left ventricle systolic function. Kardiologiia. 2019;59(5S):37–46. DOI: 10.18087/cardio.2617

10. Koval S.M., Snigurska I.O. Risk Factors of Atrial Fibrillation and Outstanding Issues of Its Prevention. Hypertension. 2016;5(49):61–9. DOI: 10.22141/2224-1485.5.49.2016.83866

11. Velikanova E.A., Golovkin A.S., Matveeva V.G. Systemic inflammatory response in cardiac surgery. Ed. Barbarash L.S., Grigoriev E.V. - Kemerovo: Kuzbassvuzizdat;2013. - 149 p. ISBN 978-5-202-01182-5

12. Shevchenko Yu.L., Viller A.G., Borschev G.G., Litvinov A.A. The role of extra- and intracardiac circulation in patients with chronic coronary artery disease. Bulletin of Pirogov National Medical & Surgical Center. 2018;13(4):10–7. DOI: 10.25881/BPNMSC.2018.77.39.002

13. Dobrev D, Aguilar M, Heijman J, Guichard J-B, Nattel S. Postoperative atrial fibrillation: mechanisms, manifestations and management. Nature Reviews Cardiology. 2019;16(7):417–36. DOI: 10.1038/s41569-019-0166-5

14. Kolesnikov V.N., Ivanenko A.S., Krasnov A.Yu., Bulgakova N.E., Kokorin V.A., Yagoda A.V. et al. New-onset atrial fibrillation after coronary artery bypass grafting: risk prediction model. Creative Cardiology. 2017;11(2):118–28. DOI: 10.24022/1997-3187-2017-11-2-118-128