Hemodynamic predictors of atrial fibrillation or flutter after coronary artery bypass grafting

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Abstract
The cumulated incidence of atrial fibrillation or flutter after coronary artery bypass grafting is 30%. The causes of these arrhythmias have not yet been sufficiently identified. We therefore undertook the present study to analyze the possible association of hemodynamic function during the various phases of coronary artery bypass grafting and the later development of atrial fibrillation/flutter. Hemodynamic function was measured with a pulmonary artery catheter in 120 consecutive patients undergoing elective coronary artery bypass surgery. Thirty-five (29%) of the patients developed atrial fibrillation/flutter. Logistic regression analysis identified independent predictors of atrial fibrillation/flutter. After induction of general anesthesia, the relative risk (95% confidence interval) of older age was 1.09/year (1.03-1.16), and the reduction in relative risk by an increase in left ventricular stroke work was 0.96/gm (0.93-0.99). After weaning from the extracorporeal circulation the independent significant predictors were age, relative risk 1.07/year (1.01-1.13), and increased central venous pressure, relative risk 1.12/mm Hg (1.00-1.26). At the time of admission to the intensive care unit, the relative risk of age was 1.10/year (1.03-1.18), and the relative risk of an increased central venous pressure was 1.26/mm Hg (1.06-1.49). However, the best prediction model (prediction after induction of general anesthesia) only provided a median predicted probability of atrial fibrillation/flutter of 0.37 for the patients who had atrial fibrillation/flutter, and a median predicted probability of atrial fibrillation/flutter of 0.20 for the patients without these arrhythmias. We identified possible hemodynamic predictors of atrial fibrillation/flutter after coronary bypass surgery, but the use of a risk stratification for development of atrial fibrillation/flutter based on hemodynamic function cannot be recommended.