×
Home Current Archive Editorial board
News Contact
Review paper

New-onset atrial fibrillation after percutaneous coronary intervention or coronary artery bypass grafting for left main disease

By
Harun Avdagić Orcid logo ,
Harun Avdagić
Contact Harun Avdagić

Clinic for Cardiovascular Surgery, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina

Ivana Iveljić ,
Ivana Iveljić

Clinic for Invasive Cardiology, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina

Elmir Jahić ,
Elmir Jahić

Clinic for Cardiovascular Surgery, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina

Selma Sijerčić ,
Selma Sijerčić

Clinic for Anesthesiology, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina

Alisa Krdžalić ,
Alisa Krdžalić

Clinic for Cardiovascular Surgery, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina

Amar Skakić ,
Amar Skakić

University Clinical Center Tuzla, Clinic for Cardiovascular Surgery, Tuzla, Bosnia and Herzegovina

Jasenko Radović ,
Jasenko Radović

Clinic for Invasive Cardiology, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina

Emir Ahmetašević
Emir Ahmetašević

Clinic for Surgery, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina

Abstract

Aim
To determine the prevalence of new-onset atrial fibrillation (NOAF) following percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) for left main coronary artery disease (LMCAD) and its effect on 6-month cardiovascular outcomes.
Methods
This prospective study included 40 patients diagnosed with LMCAD, in the period from 2017 to 2018. The patients with LMCAD and low or intermediate SYNTAX score were randomized to PCI with zotarolimus-eluting stents versus CABG. Outcomes were analyzed according to the development of NOAF during the initial hospitalization following revascularization. Results
Among 40 patients without atrial fibrillation on presentation, NOAF developed 3.1±1.3 days during hospitalization in three CABG treated patients, and one PCI treated patient. One patient that was CABG treated developed NOAF after two months. Patients with versus patients without NOAF had a significantly longer duration of hospitalization, probably because they were discharged on anticoagulant therapy. Myocardial infarction was presented in one CABG treated patient after 3 months, and also in one PCI treated patient after 4 months. One patient died 2 months after the operation, and one developed stroke 5 months after the CABG operation.
Conclusion
The NOAF was common after CABG, but extremely rare after PCI, and it occurred almost exclusively following CABG. There was a clear statistical tendency for all-cause death, cardiovascular death and stroke at 6-month follow-up period.

References

1.
Kaw R, Hernandez A, Masood I, Gillinov A, Saliba W, Blackstone E. Short-and long-term mortality associated with new-onset atrial fibrillation after coronary artery bypass grafting: A systematic review and meta-analysis. J Thorac Cardiovasc Surg. 2011. p. 1305–12.
2.
Knotzer H, Dunser M, Mayr A, Hasibeder W. Postbypass arrhythmias: patopshyhology, prevention, and therapy. Curr Opin Crit Care. 2004. p. 330–5.
3.
Sy M, Park D, Yun S, Kim Y, Lee J, Kang S, et al. Major predictors of long-term clinical outcomes after coronary revascularization in patients with unprotected left main coronary disease: analysis from the MAIN-COMPARE study. Circ Cardiovasc Interv. 2010. p. 127–33.
4.
Stone G, Sabik J, Serruyus P, Simonton C, Genereux P, Puskas J, et al. Everolimus-eluting stents or bypass surgery for left main coronary artery disease. N Engl J Med. 2016. p. 2223–35.
5.
Makaikallio T, Holm N, Lindsay M, Spence M, Erglis A, Menown I, et al. Percutaneous coronary angioplasty versus coronary artery bypass grafting in treatment of unprotected left main stenosis (NOBLE ): a prospective, randomised. Lancet. 2016. p. 2743–52.
6.
Head S, Farooq V, Serruys P, Kappetein A. The SYNTAX score and its clinical implications. Heart. 2014. p. 169–77.
7.
Arom K, Emery R, Petersen R, Bero J. Evaluation of 7,000 patients with two different routes of cardioplegia. Ann Thorac Surg. 1997. p. 1619–24.
8.
Neumann FJ, Sousa-Uva M, Ahlsson A, Alfonso F, Banning A, Benedetto U, et al. ESC/EACTS Guidelines on myocardial revascularization. Eur Heart J. 2018. p. 87–165.
9.
Echahidi N, Pibarot P, Hara O, Mathieu G, P. Mechanisms, prevention, and treatment of atrial fibrillation after cardiac surgery. J Am Coll Cardiol. 2008. p. 793–801.
10.
Chelazzi C, Villa G, Gaudio D, A. Postoperative atrial fibrillation. ISRN Cardiol. 2011. p. 203179.
11.
Antonic M, Lipovec R, Gregorcic F, Juric P, Kosir G. Perioperative ascorbic acid supplementation does not reduce the incidence of postoperative atrial fibrillation in on-pump coronary artery bypass graft patients. J Cardiol. 2017. p. 98–102.
12.
Ommen S, Odell J, Stanton M. Atrial arrhythmias after cardiothoracic surgery. N Engl J Med. 1997. p. 1429–34.
13.
Almassi G, Pecsi S, Collins J, Shroyer A, Zenati M, Grover F. Predictors and impact of postoperative atrial fibrillation on patients’ outcomes: a report from the Randomized On Versus Off Bypass trial. J Thorac Cardiovasc Surg. 2012. p. 93–102.
14.
Kuss O, Salviati V, Borgermann B, J. Off pump versus on-pump coronary artery bypass grafting: a systematic review and meta-analysis of propensity score analyses. J Thorac Cardiovasc Surg. 2010. p. 829–35.
15.
Capodanno D, Stone G, Morice M, Bass T, Tamburino C. Percutaneous coronary intervention versus coronary artery bypass graft surgery in left main coronary artery disease: a meta-analysis of randomized clinical data. J Am Coll Cardiol. 2011. p. 1426–32.
16.
Palmerini T, Biondi-Zoccai G, Reggiani L, Sangiorgi D, Alessi L, Servi D, et al. Risk of stroke with coronary artery bypass graft surgery compared with percutaneous coronary intervention. J Am Coll Cardiol. 2012. p. 798–805.
17.
Horwich P, Buth K, Legare J. New onset postoperative atrial fibrillation is associated with a longterm risk for stroke and death following cardiac surgery. J Card Surg. 2013. p. 8–13.
18.
Melduni R, Schaff H, Bailey K, Cha S, Ammash N, Seward J, et al. Implications of new-onset atrial fibrillation after cardiac surgery on long-term prognosis: a community-based study. Am Heart J. 2015. p. 659–68.
19.
Reiffel J, Verma A, Kowey P, Halperin J, Gersh B, Wachter R, et al. Incidence of previously undiagnosed atrial fibrillation using insertable cardiac monitors in a high-risk population: the REVEAL AF study. JAMA Cardiol. 2017. p. 1120–7.

Citation

Authors retain copyright. This work is licensed under a Creative Commons Attribution 4.0 International License. Creative Commons License

 

Article metrics

Google scholar: See link

The statements, opinions and data contained in the journal are solely those of the individual authors and contributors and not of the publisher and the editor(s). We stay neutral with regard to jurisdictional claims in published maps and institutional affiliations.