Predictors of New-Onset Atrial Fibrillation in Patients With Chronic Coronary Artery Disease After Coronary Artery Bypass Grafting: a Prospective, Observational, Single-Centre, Non-Randomized Study

Aim. To study the factors that influence the occurrence of postoperative atrial fibrillation (POAF) in patients with chronic ischemic heart disease (IHD) after coronary artery bypass grafting (CABG).

Material and methods. This single-center prospective observational non-randomized study included 152 patients with chronic IHD. Mean age of patients was 64.4±5.9 years. All patients after CABG were divided into two groups based on the occurrence of atrial fibrillation (AF) in the early postoperative period: group 1, with POAF (n=43; 28.3%) and group 2, without POAF (n=109; 71.7%). The primary study endpoint was new-onset POAF in the early postoperative (hospital) period after CABG. The secondary study endpoint was in-hospital postoperative complications (non-fatal/fatal acute coronary syndrome (ACS), non-fatal/fatal stroke, major bleeding, death).

Results. Patients with POAF had significantly more pronounced structural and functional changes in the heart than patients with preserved sinus rhythm after CABG: larger left ventricular (LV) volume, greater LV myocardial mass, lower LV systolic function parameters and impaired diastolic function, and an enlarged left atrial (LA) cavity. Analysis of in-hospital complications did not show any differences between the groups associated with the development of POAF. The following risk factors for POAF were identified: age older than 65 years (p=0.022), body mass index ≥30.5 kg/m2 (p=0.020), epicardial adipose tissue thickness >10.5 mm (p=0.015), indexed LA volume >33 ml/m2 (p<0.001), LV myocardial mass index >115 g/m2 (p=0.042), left main coronary artery disease >50% (p=0.043), duration of cardiopulmonary bypass during CABG >60 min (p=0.019), blood potassium concentration in the early postoperative period after CABG (on the first day) <3.6 mmol/l (p<0.001), and pericardial effusion volume in the early postoperative period >88 ml (p<0.001).

Conclusion. Determining the risk of developing POAF is important and necessary for the closest monitoring of a patient with chronic IHD in the postoperative period.

1. Villareal RP, Hariharan R, Liu BC, Kar B, Lee V-V, Elayda M et al. Postoperative atrial fibrillation and mortality after coronary artery bypass surgery. Journal of the American College of Cardiology. 2004;43(5):742–8. DOI: 10.1016/j.jacc.2003.11.023

2. Biancari F, Asim Mahar MA, Kangasniemi O-P. CHADS2 and CHA2DS2-VASc Scores for Prediction of Immediate and Late Stroke after Coronary Artery Bypass Graft Surgery. Journal of Stroke and Cerebrovascular Diseases. 2013;22(8):1304–11. DOI: 10.1016/j.jstrokecerebrovasdis.2012.11.004

3. Sokolova N.Yu., Savelyeva E.A., Popov D.A., Martynova K.A. Epidemiological and pathogenetic mechanisms of atrial fibrillation depending on the influence of concomitant pathology, coronary artery bypass grafting and previous novel coronavirus infection. Creative cardiology. 2022;16(3):302–12. DOI: 10.24022/1997-3187-2022-16-3-302-312

4. Ganaev K.G., Vlasova E.E., Shiryaev A.A., Vasiliev V.P., Galyautdinov D.M., Ilyina L.N. et al. Atrial fibrillation after coronary artery bypass grafting in patients with local and diffuse coronary artery disease. Russian Cardiology Bulletin. 2021;16(2):59–64. DOI: 10.17116/Cardiobulletin20211602159

5. Sokolova N.Yu., Golukhova E.Z., Savelyeva E.A., Popov D.S. The state of cognitive function in patients with stable coronary artery disease after coronary artery bypass grafting. Kardiologiia. 2021;61(9):40–6. DOI: 10.18087/cardio.2021.9.n1514

6. Calkins H, Kuck KH, Cappato R, Brugada J, Camm AJ, Chen S-A et al. 2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design. Europace. 2012;14(4):528–606. DOI: 10.1093/europace/eus027

7. Parisi V, Petraglia L, Formisano R, Caruso A, Grimaldi MG, Bruzzese D et al. Validation of the echocardiographic assessment of epicardial adipose tissue thickness at the Rindfleisch fold for the prediction of coronary artery disease. Nutrition, Metabolism and Cardiovascular Diseases. 2020;30(1):99–105. DOI: 10.1016/j.numecd.2019.08.007

8. Mach F, Baigent C, Catapano AL, Koskinas KC, Casula M, Badimon L et al. 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. Russian Journal of Cardiology. 2020;25(5):121–93. DOI: 10.15829/1560-4071-2020-3826

9. Neumann F-J, Sousa-Uva M, Ahlsson A, Alfonso F, Banning AP, Benedetto U et al. 2018 ESC/EACTS guidelines on myocardial revascularization. Russian Journal of Cardiology. 2019;24(8):151–226. DOI: 10.15829/1560-4071-2019-8-151-226

10. Berger M, Terrando N, Smith SK, Browndyke JN, Newman MF, Mathew JP. Neurocognitive Function after Cardiac Surgery: from phenotypes to mechanisms. Anesthesiology. 2018;129(4):829–51. DOI: 10.1097/ALN.0000000000002194

11. Mingalimova A.R., Drapkina O.M., Sagirov M.A., Mazanov M.Kh., Bikbova M.M., Argir I.A. Inflammatory continuum in the pathogenesis of atrial fibrillation after coronary bypass surgery. Cardiovascular Therapy and Prevention. 2022;21(3):99–107. DOI: 10.15829/1728-8800-2022-3094

12. Elahi MM, Flatman S, Matata BM. Tracing the origins of postoperative atrial fibrillation: the concept of oxidative stress-mediated myocardial injury phenomenon. European Journal of Cardiovascular Prevention & Rehabilitation. 2008;15(6):735–41. DOI: 10.1097/HJR.0b013e328317f38a

13. Xiong T, Pu L, Ma Y-F, Zhu Y-L, Li H, Cui X et al. Posterior pericardiotomy to prevent new-onset atrial fibrillation after coronary artery bypass grafting: a systematic review and meta-analysis of 10 randomized controlled trials. Journal of Cardiothoracic Surgery. 2021;16(1):233. DOI: 10.1186/s13019-021-01611-x

14. Lancaster TS, Schill MR, Greenberg JW, Moon MR, Schuessler RB, Damiano RJ et al. Potassium and Magnesium Supplementation Do Not Protect Against Atrial Fibrillation After Cardiac Operation: A Time-Matched Analysis. The Annals of Thoracic Surgery. 2016;102(4):1181–8. DOI: 10.1016/j.athoracsur.2016.06.066

15. Howitt SH, Grant SW, Campbell NG, Malagon I, McCollum C. Are Serum Potassium and Magnesium Levels Associated with Atrial Fibrillation After Cardiac Surgery? Journal of Cardiothoracic and Vascular Anesthesia. 2020;34(5):1152–9. DOI: 10.1053/j.jvca.2019.10.045

16. Podzolkov V.I., Tarzimanova A.I., Bragina A.E., Osadchiy K.K., Gataulin R.G., Oganesyan K.A. et al. Role of epicardial adipose tissue in the development of atrial fibrillation in hypertensive patients. Cardiovascular Therapy and Prevention. 2020;19(6):12–7. DOI: 10.15829/1728-8800-2020-2707

17. Hatem SN, Sanders P. Epicardial adipose tissue and atrial fibrillation. Cardiovascular Research. 2014;102(2):205–13. DOI: 10.1093/cvr/cvu045

18. Petraglia L, Conte M, Comentale G, Cabaro S, Campana P, Russo C et al. Epicardial Adipose Tissue and Postoperative Atrial Fibrillation. Frontiers in Cardiovascular Medicine. 2022;9:810334. DOI: 10.3389/fcvm.2022.810334

19. Feng T, Vegard M, Strand LB, Laugsand LE, Mørkedal B, Aune D et al. Weight and weight change and risk of atrial fibrillation: the HUNT study. European Heart Journal. 2019;40(34):2859–66. DOI: 10.1093/eurheartj/ehz390

20. Greenberg JW, Lancaster TS, Schuessler RB, Melby SJ. Postoperative atrial fibrillation following cardiac surgery: a persistent complication. European Journal of Cardio-Thoracic Surgery. 2017;52(4):665–72. DOI: 10.1093/ejcts/ezx039

21. Perutsky D.N., Obrezan A.G., Osipova O.A., Zarudsky A.A. Left atrial function in patients with heart failure. Cardiovascular Therapy and Prevention. 2022;21(6):108–14. DOI: 10.15829/1728-8800-2022-3265

22. Ozben B, Akaslan D, Sunbul M, Filinte D, Ak K, Sari İ et al. Postoperative Atrial Fibrillation after Coronary Artery Bypass Grafting Surgery: A Two-dimensional Speckle Tracking Echocardiography Study. Heart, Lung and Circulation. 2016;25(10):993–9. DOI: 10.1016/j.hlc.2016.02.003

23. Rizvi F, Mirza M, Olet S, Albrecht M, Edwards S, Emelyanova L et al. Noninvasive biomarker-based risk stratification for development of new onset atrial fibrillation after coronary artery bypass surgery. International Journal of Cardiology. 2020;307:55–62. DOI: 10.1016/j.ijcard.2019.12.067