Risk index for A-Fib after cardiac surgery, Dr. Trivedi

Puja Trivedi, DO

PGY-3 Resident at RCRMC who will do a Cardiac Anesthesia Fellowship at USC upon graduation

Article Review

A multicenter risk index for atrial fibrillation after cardiac surgery. Mathew JP, Fontes ML, Tudor IC, Ramsay J, Duke P, Mazer CD, Barash PG, Hsu PH, Mangano DT; Investigators of the Ischemia Research and Education Foundation; Multicenter Study of Perioperative Ischemia Research Group. JAMA. 2004 Apr 14;291(14):1720-9.

AFIB is the most common sustained rhythm disturbance, affecting 2.3 million people in the United States and is the  most common complication after cardiac surgery is AF (20-60%). Matthew et al set out to develop a comprehensive risk index that can better identify patients at risk for atrial fibrillation undergoing CABG. This was a prospective, observational study which included 5,436 patients from 70 hospitals, spanning 17 countries; the largest study to this date. Patient inclusion criteria included all patients 18 years and over scheduled for a CABG +/- valve repair using cardiopulmonary bypass between 11/1996-6/2000.

The study found that preoperatively advanced age, history of atrial fibrillation and COPD had the highest correlation to post operative development of atrial fibrillation. Intraoperatively, valve surgery with its inherent disruption of cardiac anatomy proved to have the highest post operative arrythrogenic implications. Post operatively, electrolyte disturbances and delays in resuming beta blockers and ace inhibitors showed the highest correlation in the development of atrial fibrillation.

The extent of extra medical intervention and increased hospital days mandates more aggressive therapies aimed at prevention of post operative atrial fibrillation.